Provider Demographics
NPI:1447705454
Name:KROKENBERGER, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:KROKENBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 CROSSPOINTE LN STE 6
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2986
Mailing Address - Country:US
Mailing Address - Phone:585-347-4990
Mailing Address - Fax:585-347-4993
Practice Address - Street 1:1130 CROSSPOINTE LN STE 6
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2986
Practice Address - Country:US
Practice Address - Phone:585-347-4990
Practice Address - Fax:585-347-4993
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist