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General NPI Number Information
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NPI Number | 1245111897
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Entity Type | Individual
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Provider Name | ALYSSA GRACE BEVACQUA
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Gender | Female
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 43 YAWPO AVE STE 10
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City | OAKLAND
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State | NJ
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Zip | 07436-2717
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Country | US
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Telephone | 201-337-3307
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Fax |
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Provider Business Mailing Address
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Address Line | 241 DIVISION AVE
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City | HASBROUCK HEIGHTS
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State | NJ
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Zip | 07604-1719
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02356000
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License Number State | NJ
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