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General NPI Number Information
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NPI Number | 1710130596
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Entity Type | Individual
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Provider Name | MICHAEL JOSEPH KONETSKY PT, DPT, OCS
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Gender | Male
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Dates
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Enumeration Date | 10/24/2008
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | USA MEDDAC FORT EUSTIS
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City | FORT EUSTIS
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State | VA
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Zip | 23185
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Country | US
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Telephone | 757-314-7640
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Fax |
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Provider Business Mailing Address
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Address Line | 3709 GOVERNOR YEARDLEY LN
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-1489
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Country | US
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Telephone | 808-341-5423
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State | PA
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