Provider Demographics
NPI:1255627394
Name:TANTY, JOCELYN PIDAL (PT)
Entity type:Individual
Prefix:MISS
First Name:JOCELYN
Middle Name:PIDAL
Last Name:TANTY
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 1:160 EAST MAIN STREET
Mailing Address - Street 2:GENESIS - BON SECOURS COMMUNITY HOSPITAL/ST. JOSEPHS
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 EAST MAIN STREET
Practice Address - Street 2:GENESIS - BON SECOURS COMMUNITY HOSPITAL/ST. JOSEPHS
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-0000
Practice Address - Country:US
Practice Address - Phone:845-858-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist