Provider Demographics
NPI:1598767121
Name:KONIUTO, JOHN K (PT, MSPT, DPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:K
Last Name:KONIUTO
Suffix:
Gender:M
Credentials:PT, MSPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 OAKDALE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1007
Mailing Address - Country:US
Mailing Address - Phone:607-217-0827
Mailing Address - Fax:607-217-0827
Practice Address - Street 1:153 OAKDALE RD STE 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1007
Practice Address - Country:US
Practice Address - Phone:607-217-0827
Practice Address - Fax:607-217-0827
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015184-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist