Healthcare Provider Details

I. General information

NPI: 1669371753
Provider Name (Legal Business Name): PETER LAGONEGRO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W MARKET ST
CORNING NY
14830-2519
US

IV. Provider business mailing address

529 PINEWOOD CIR
ELMIRA NY
14905-1112
US

V. Phone/Fax

Practice location:
  • Phone: 607-973-2107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number014424-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: