Provider Demographics
NPI:1306847694
Name:FERRARA, JOANN (PT)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:FERRARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 BELL BLVD
Mailing Address - Street 2:#203
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2019
Mailing Address - Country:US
Mailing Address - Phone:718-428-2600
Mailing Address - Fax:718-428-7429
Practice Address - Street 1:2391 BELL BLVD
Practice Address - Street 2:#203
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2019
Practice Address - Country:US
Practice Address - Phone:718-428-2600
Practice Address - Fax:718-428-7429
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12300Medicare UPIN
NYR27816Medicare PIN