Provider Demographics
NPI:1104458850
Name:JALLOH, ALMAMY (PT)
Entity type:Individual
Prefix:
First Name:ALMAMY
Middle Name:
Last Name:JALLOH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 DORCHESTER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1354
Mailing Address - Country:US
Mailing Address - Phone:617-929-0102
Mailing Address - Fax:
Practice Address - Street 1:1558 DORCHESTER AVE STE 202
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1354
Practice Address - Country:US
Practice Address - Phone:781-891-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist