Healthcare Provider Details

I. General information

NPI: 1750144192
Provider Name (Legal Business Name): JOANN L KUMROW PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORTON AVE
ONEONTA NY
13820-2629
US

IV. Provider business mailing address

7 MUCKEY RD
BINGHAMTON NY
13903-6825
US

V. Phone/Fax

Practice location:
  • Phone: 607-431-5000
  • Fax:
Mailing address:
  • Phone: 607-624-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number004160-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: