Provider Demographics
NPI:1124760178
Name:VILLANUEVA, ALYSSA JEANINE BERNARDO (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:ALYSSA JEANINE
Middle Name:BERNARDO
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 LENOX RD APT 5H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2692
Mailing Address - Country:US
Mailing Address - Phone:917-936-8559
Mailing Address - Fax:
Practice Address - Street 1:165 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7105
Practice Address - Country:US
Practice Address - Phone:718-253-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist