Provider Demographics
NPI:1982783031
Name:EMMANUELE, CONCETTA ANGELA (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:CONCETTA
Middle Name:ANGELA
Last Name:EMMANUELE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 GULF OF MEXICO DR PH 5
Mailing Address - Street 2:
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-2144
Mailing Address - Country:US
Mailing Address - Phone:941-383-2953
Mailing Address - Fax:
Practice Address - Street 1:6404 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2605
Practice Address - Country:US
Practice Address - Phone:941-782-0201
Practice Address - Fax:941-795-7268
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106773Medicare ID - Type Unspecified