Provider Demographics
NPI:1710954003
Name:KONNOTH, CAROLINE (BSPT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:KONNOTH
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:MRS
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:KONNOTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8411 252ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2118
Mailing Address - Country:US
Mailing Address - Phone:718-347-1469
Mailing Address - Fax:
Practice Address - Street 1:14809 NORTHERN BLVD
Practice Address - Street 2:SUITE 1K
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4346
Practice Address - Country:US
Practice Address - Phone:718-445-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-05
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018592-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist