Provider Demographics
NPI:1619398674
Name:ALLEVIANT PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:ALLEVIANT PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:NOBLEZA
Authorized Official - Last Name:VILLAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPT
Authorized Official - Phone:718-891-8822
Mailing Address - Street 1:164 BRIGHTON 11TH ST
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5327
Mailing Address - Country:US
Mailing Address - Phone:718-891-8822
Mailing Address - Fax:718-891-8823
Practice Address - Street 1:164 BRIGHTON 11TH ST
Practice Address - Street 2:FLOOR 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5327
Practice Address - Country:US
Practice Address - Phone:718-891-8822
Practice Address - Fax:718-891-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022729-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty