Provider Demographics
NPI:1700219409
Name:JONNA K.DEBLOIS PT PC
Entity Type:Organization
Organization Name:JONNA K.DEBLOIS PT PC
Other - Org Name:HOPE PHYSICAL & AQUATIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-681-5225
Mailing Address - Street 1:2 HOPE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5626
Mailing Address - Country:US
Mailing Address - Phone:516-681-5225
Mailing Address - Fax:516-681-5463
Practice Address - Street 1:2 HOPE DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-5626
Practice Address - Country:US
Practice Address - Phone:516-681-5225
Practice Address - Fax:516-681-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018085-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty