Provider Demographics
NPI:1164512018
Name:PENSAVALLE, ATTILIO S (PT DPT)
Entity Type:Individual
Prefix:DR
First Name:ATTILIO
Middle Name:S
Last Name:PENSAVALLE
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOLLOW LN STE 214
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:516-482-0100
Mailing Address - Fax:516-482-0172
Practice Address - Street 1:1 HOLLOW LN STE 214
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1215
Practice Address - Country:US
Practice Address - Phone:516-482-0100
Practice Address - Fax:516-482-0172
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006893-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist