Provider Demographics
NPI:1316211329
Name:ABALO, ALICIA (PT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:ABALO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AL
Other - Middle Name:BUCAO
Other - Last Name:ABALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:113 1/2 E 62ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7301
Mailing Address - Country:US
Mailing Address - Phone:347-840-3884
Mailing Address - Fax:
Practice Address - Street 1:113 1/2 E 62ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7301
Practice Address - Country:US
Practice Address - Phone:347-840-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist