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General NPI Number Information
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NPI Number | 1922003151
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Entity Type | Individual
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Provider Name | ALYSA LONGO MA, PT
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Gender | Female
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 175 TOMPKINS AVE
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-3144
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Country | US
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Telephone | 914-495-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 333 EARLE OVINGTON BLVD SUITE 225
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City | UNIONDALE
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State | NY
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Zip | 11553-3610
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Country | US
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Telephone | 516-321-2424
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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 | 010661
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License Number State | NY
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