Provider Demographics
NPI:1962260893
Name:PANLILIO, JOHANNA KRISTEN (PT, PTRP)
Entity type:Individual
Prefix:
First Name:JOHANNA KRISTEN
Middle Name:
Last Name:PANLILIO
Suffix:
Gender:F
Credentials:PT, PTRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OLD MAMARONECK RD APT 4G
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1714
Mailing Address - Country:US
Mailing Address - Phone:347-799-8714
Mailing Address - Fax:
Practice Address - Street 1:1053 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1048
Practice Address - Country:US
Practice Address - Phone:914-693-2350
Practice Address - Fax:914-693-7661
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY049189-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist