MEDICARE: MRS. NANCY JANE CONSTANTINO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4214-1	NY

General Provider Information

NPI Number	:	1326283227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY JANE CONSTANTINO PT

Provider Business Mailing Address
First Line	:	PO BOX 105
Second Line	:
City	:	BLOOMINGTON
State	:	NY
Zip	:	12411-0105
Country	:	US
Telephone Number	:	845-331-4716
Fax Number	:

Provider Business Practice Location Address
First Line	:	4246 ALBANY POST RD
Second Line	:	SUITE 1
City	:	HYDE PARK
State	:	NY
Zip	:	12538-1700
Country	:	US
Telephone Number	:	845-229-6044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	12/05/2008

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