MEDICARE: WALESKA ALAMO PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	TE008318	PA

General Provider Information

NPI Number	:	1548579584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALESKA ALAMO PTA

Provider Business Mailing Address
First Line	:	5715 N 4TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2323
Country	:	US
Telephone Number	:	215-400-0419
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 ARAMINGO AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-4500
Country	:	US
Telephone Number	:	215-427-2242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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Directions to “ WALESKA ALAMO PTA” Practice Location

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