Provider Demographics
NPI:1427713932
Name:BALLOGDAJAN, STEPHANIE VIRAYO (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:VIRAYO
Last Name:BALLOGDAJAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 MIDLAND PKWY APT 4H
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4711
Mailing Address - Country:US
Mailing Address - Phone:201-539-4014
Mailing Address - Fax:
Practice Address - Street 1:8701 MIDLAND PKWY APT 4H
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4711
Practice Address - Country:US
Practice Address - Phone:201-539-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist