Provider Demographics
NPI:1447235726
Name:MCCONLOGUE, JOANNE MARGARET (MS PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARGARET
Last Name:MCCONLOGUE
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:127 HOSPITAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2500
Mailing Address - Country:US
Mailing Address - Phone:707-552-8795
Mailing Address - Fax:707-552-9638
Practice Address - Street 1:127 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2500
Practice Address - Country:US
Practice Address - Phone:707-552-8795
Practice Address - Fax:707-552-9638
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPT15484225100000X
CAPT 43438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5491514OtherAETNA
P00120492OtherRAILROAD MEDICARE
97897OtherMEDCOST
1035GOtherBCBS
805158OtherPARTNERS MEDICARE
97897OtherMEDCOST
97897OtherMEDCOST