Provider Demographics
NPI:1992457683
Name:PATAWARAN, KARMELA ALYSSANDRA REYES (DPT, PT)
Entity type:Individual
Prefix:
First Name:KARMELA ALYSSANDRA
Middle Name:REYES
Last Name:PATAWARAN
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:KARMELA ALYSSANDRA
Other - Middle Name:SY
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT
Mailing Address - Street 1:294 CORDIAL RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-2604
Mailing Address - Country:US
Mailing Address - Phone:718-510-6743
Mailing Address - Fax:
Practice Address - Street 1:294 CORDIAL RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-2604
Practice Address - Country:US
Practice Address - Phone:718-510-6743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042233-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist