Provider Demographics
NPI:1295860336
Name:LLARENA, ALEXIS NIEVA (PT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NIEVA
Last Name:LLARENA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 CASPIAN DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-9061
Mailing Address - Country:US
Mailing Address - Phone:717-764-0171
Mailing Address - Fax:
Practice Address - Street 1:970 COLONIAL AVE
Practice Address - Street 2:COLONIAL MANOR NURSING HOME AND REHABILITATION CENTER
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3430
Practice Address - Country:US
Practice Address - Phone:717-845-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008108L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist