Provider Demographics
NPI:1932247590
Name:HISOLE CEBALLOS, LEILA MONTEFRIO (BSPT)
Entity type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:MONTEFRIO
Last Name:HISOLE CEBALLOS
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2141 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1301
Mailing Address - Country:US
Mailing Address - Phone:631-940-9317
Mailing Address - Fax:631-254-0784
Practice Address - Street 1:2141 DEER PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-1301
Practice Address - Country:US
Practice Address - Phone:631-940-9317
Practice Address - Fax:631-254-0784
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist