Healthcare Provider Details

I. General information

NPI: 1700219409
Provider Name (Legal Business Name): JONNA K.DEBLOIS PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HOPE DR
PLAINVIEW NY
11803-5626
US

IV. Provider business mailing address

2 HOPE DR
PLAINVIEW NY
11803-5626
US

V. Phone/Fax

Practice location:
  • Phone: 516-681-5225
  • Fax: 516-681-5463
Mailing address:
  • Phone: 516-681-5225
  • Fax: 516-681-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018085-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. SHAY WALLACE
Title or Position: OFFICE MANAGER
Credential:
Phone: 516-681-5225