Provider Demographics
NPI:1396229324
Name:SEMANERO, JOANNA PAULA IBAOS
Entity Type:Individual
Prefix:
First Name:JOANNA PAULA
Middle Name:IBAOS
Last Name:SEMANERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10022 SE 172ND AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-9630
Mailing Address - Country:US
Mailing Address - Phone:917-859-3631
Mailing Address - Fax:
Practice Address - Street 1:1620 OHM AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1017
Practice Address - Country:US
Practice Address - Phone:315-237-7121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040632225100000X
OR63170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist