Provider Demographics
NPI:1871682880
Name:CIANI, MARY JOAN (PT)
Entity Type:Individual
Prefix:
First Name:MARY JOAN
Middle Name:
Last Name:CIANI
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:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-0103
Mailing Address - Country:US
Mailing Address - Phone:518-479-0024
Mailing Address - Fax:518-479-0962
Practice Address - Street 1:RR1 RTE 32 SOUTH
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12083
Practice Address - Country:US
Practice Address - Phone:518-966-4568
Practice Address - Fax:518-966-4569
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004603-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01112707Medicaid
NYQP2611Medicare ID - Type Unspecified