Healthcare Provider Details

I. General information

NPI: 1548579584
Provider Name (Legal Business Name): WALESKA ALAMO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 ARAMINGO AVE
PHILADELPHIA PA
19134-4500
US

IV. Provider business mailing address

5715 N 4TH ST
PHILADELPHIA PA
19120-2323
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-2242
  • Fax:
Mailing address:
  • Phone: 215-400-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE008318
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: