Provider Demographics
NPI:1760606834
Name:KARACOLOFF, LINDA ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:KARACOLOFF
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 1:57 FERNBANK AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-4027
Mailing Address - Country:US
Mailing Address - Phone:518-439-3637
Mailing Address - Fax:518-439-3768
Practice Address - Street 1:57 FERNBANK AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-4027
Practice Address - Country:US
Practice Address - Phone:518-439-3637
Practice Address - Fax:518-439-3768
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist