Provider Demographics
NPI:1194988022
Name:SUMAGAYSAY, ACE GONZALES (PT)
Entity type:Individual
Prefix:
First Name:ACE
Middle Name:GONZALES
Last Name:SUMAGAYSAY
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 1:5875 NIGHT WIND CIR
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-6475
Mailing Address - Country:US
Mailing Address - Phone:718-564-3687
Mailing Address - Fax:315-299-5319
Practice Address - Street 1:5875 NIGHT WIND CIR
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-6475
Practice Address - Country:US
Practice Address - Phone:718-564-3687
Practice Address - Fax:315-359-6778
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027980-1225100000X
NY0279802251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty