Provider Demographics
NPI:1548448012
Name:PONESSA, JOSEPH III (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:PONESSA
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EMMA LANE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-383-2610
Mailing Address - Fax:518-383-8188
Practice Address - Street 1:4 EMMA LANE
Practice Address - Street 2:SUITE 401
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-383-2610
Practice Address - Fax:518-383-8188
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0298801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist