Basic Information
| Provider Information | |||||||||
| NPI: | 1558484683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANGACCIO | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 ODELL CIR | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125501525 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 51-55 NORTH ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | WEST HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457864617 | ||||||||
| FaxNumber: | 8457864068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 016290-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.