Provider Demographics
NPI:1477820710
Name:COONRADT, JOANNE P (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:P
Last Name:COONRADT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:P
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:245 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12122
Mailing Address - Country:US
Mailing Address - Phone:518-827-3600
Mailing Address - Fax:
Practice Address - Street 1:245 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEBURGH
Practice Address - State:NY
Practice Address - Zip Code:12122
Practice Address - Country:US
Practice Address - Phone:518-827-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003901-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist