Provider Demographics
NPI:1356470371
Name:CONCA, JEANNE MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:CONCA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 SLY PARK RD
Mailing Address - Street 2:
Mailing Address - City:POLLOCK PINES
Mailing Address - State:CA
Mailing Address - Zip Code:95726-9007
Mailing Address - Country:US
Mailing Address - Phone:530-647-2151
Mailing Address - Fax:530-647-2151
Practice Address - Street 1:3060 SNOWS RD
Practice Address - Street 2:
Practice Address - City:CAMINO
Practice Address - State:CA
Practice Address - Zip Code:95709-9578
Practice Address - Country:US
Practice Address - Phone:530-644-5915
Practice Address - Fax:530-644-5576
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist