Basic Information
| Provider Information | |||||||||
| NPI: | 1497753230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORFONTA | ||||||||
| FirstName: | KARA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 KIRKLAND AVE | ||||||||
| Address2: | SUITE 201/202 | ||||||||
| City: | CLINTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133231426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158531401 | ||||||||
| FaxNumber: | 3158537629 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 KIRKLAND AVE | ||||||||
| Address2: | SUITE 201/202 | ||||||||
| City: | CLINTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133231426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158531401 | ||||||||
| FaxNumber: | 3158537629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 022650-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 4141955 | 01 | NY | MVP | OTHER |