Healthcare Provider Details

I. General information

NPI: 1851523294
Provider Name (Legal Business Name): JOHNNA KATRINA VALERIO P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 COLUMBUS AVE
STATEN ISLAND NY
10304-4325
US

IV. Provider business mailing address

1099 TARGEE ST
STATEN ISLAND NY
10304-4310
US

V. Phone/Fax

Practice location:
  • Phone: 718-448-3210
  • Fax: 718-816-7417
Mailing address:
  • Phone: 718-448-3210
  • Fax: 718-720-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number024279
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: