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NPI Code Detail

MEDICARE: KERRIANNE MAIRE SANICOLA

MEDICARE: KERRIANNE MAIRE SANICOLA
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
1225100000XPhysical Therapist042242NY

General Provider Information

NPI Number : 1992346167
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRIANNE MAIRE SANICOLA
Provider Business Mailing Address
First Line : 69 ACADEMY RD
Second Line :
City : ALBANY
State : NY
Zip : 12208-3104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3374 FRANKLIN AVE
Second Line :
City : MILLBROOK
State : NY
Zip : 12545-5969
Country : US
Telephone Number : 845-677-3251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2019
Last Update Date : 09/30/2019

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Directions to “ KERRIANNE MAIRE SANICOLA ” Practice Location

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