Provider Demographics
NPI:1659102507
Name:PODURGIEL, JOSEPH ANTHONY (DPT)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:PODURGIEL
Suffix:
Gender:M
Credentials:DPT
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Mailing Address - Street 1:4901 LAC DE VILLA BLVD
Mailing Address - Street 2:BUILDING D; SUITE 250
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5647
Mailing Address - Country:US
Mailing Address - Phone:585-341-9200
Mailing Address - Fax:585-340-5955
Practice Address - Street 1:4901 LAC DE VILLA BLVD
Practice Address - Street 2:BUILDING D; SUITE 250
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5647
Practice Address - Country:US
Practice Address - Phone:585-341-9200
Practice Address - Fax:585-340-5955
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPT6805225100000X
NY052420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist