Provider Demographics
NPI:1962769174
Name:ALEGATA, MARY LESLIE JOY MORENO (PT)
Entity type:Individual
Prefix:
First Name:MARY LESLIE JOY
Middle Name:MORENO
Last Name:ALEGATA
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 1:4848 PIN OAK PARK APT 1416
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2294
Mailing Address - Country:US
Mailing Address - Phone:206-419-1828
Mailing Address - Fax:
Practice Address - Street 1:4848 PIN OAK PARK APT 1416
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2294
Practice Address - Country:US
Practice Address - Phone:206-419-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60157188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist