Healthcare Provider Details

I. General information

NPI: 1992474928
Provider Name (Legal Business Name): ALISSA COONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

4 DAMASCUS WAY
BALLSTON SPA NY
12020-3910
US

V. Phone/Fax

Practice location:
  • Phone: 855-855-6484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberP25000
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: