Provider Demographics
NPI:1851523294
Name:VALERIO, JOHNNA KATRINA (PT)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:KATRINA
Last Name:VALERIO
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 1:1099 TARGEE ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4310
Mailing Address - Country:US
Mailing Address - Phone:718-448-3210
Mailing Address - Fax:718-720-1271
Practice Address - Street 1:65 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4325
Practice Address - Country:US
Practice Address - Phone:718-448-3210
Practice Address - Fax:718-816-7417
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist