Healthcare Provider Details

I. General information

NPI: 1144773441
Provider Name (Legal Business Name): ALYSSA OGNIBENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FOOTE AVE
JAMESTOWN NY
14701-7077
US

IV. Provider business mailing address

207 FOOTE AVE
JAMESTOWN NY
14701-7077
US

V. Phone/Fax

Practice location:
  • Phone: 716-664-8295
  • Fax:
Mailing address:
  • Phone: 203-609-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13540-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: