Provider Demographics
NPI:1770861494
Name:CAROLINE KONNOTH PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:CAROLINE KONNOTH PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KONNOTH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-508-6906
Mailing Address - Street 1:14809 NORTHERN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4346
Mailing Address - Country:US
Mailing Address - Phone:718-359-1006
Mailing Address - Fax:718-359-4123
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:718-359-1006
Practice Address - Fax:718-359-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy