Provider Demographics
NPI:1508947144
Name:CONGDON, JANICE D (PT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:D
Last Name:CONGDON
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 1:1859 TRUMANSBURG RD.
Mailing Address - Street 2:PO BOX 122
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14854-0122
Mailing Address - Country:US
Mailing Address - Phone:607-387-5729
Mailing Address - Fax:607-387-5315
Practice Address - Street 1:1859 TRUMANSBURG RD.
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:14854-0122
Practice Address - Country:US
Practice Address - Phone:607-387-5729
Practice Address - Fax:607-387-5315
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004048-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY803886OtherACN GROUP
NYRA7875Medicare ID - Type Unspecified