Healthcare Provider Details

I. General information

NPI: 1639085186
Provider Name (Legal Business Name): JACQUELYN ALYSE ALBARRACIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELYN ALYSE HILE PTA

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 SUNRISE HWY
BAY SHORE NY
11706-6021
US

IV. Provider business mailing address

90 BAYVIEW AVE
BAYPORT NY
11705-2110
US

V. Phone/Fax

Practice location:
  • Phone: 631-446-1480
  • Fax:
Mailing address:
  • Phone: 626-417-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015524
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: