Provider Demographics
NPI:1861693459
Name:SHTULSAFT, ALISON (PT)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:
Last Name:SHTULSAFT
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 1:20 CANTERBURY CT
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3708
Mailing Address - Country:US
Mailing Address - Phone:631-928-0234
Mailing Address - Fax:
Practice Address - Street 1:20 CANTERBURY CT
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3708
Practice Address - Country:US
Practice Address - Phone:631-928-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006233-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist