Provider Demographics
NPI:1598508566
Name:MUNOZ, ALYSSA MAE BARREDA
Entity type:Individual
Prefix:
First Name:ALYSSA MAE
Middle Name:BARREDA
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 QUEENS BLVD APT 4C
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4588
Mailing Address - Country:US
Mailing Address - Phone:917-912-7535
Mailing Address - Fax:
Practice Address - Street 1:4303 48TH AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-6241
Practice Address - Country:US
Practice Address - Phone:929-522-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013994-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant