Provider Demographics
NPI:1386856367
Name:BAPP, RISSA M (PTA)
Entity Type:Individual
Prefix:
First Name:RISSA
Middle Name:M
Last Name:BAPP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 STUMP ST
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-2042
Mailing Address - Country:US
Mailing Address - Phone:518-798-5285
Mailing Address - Fax:
Practice Address - Street 1:37 EVERTS AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12804-2040
Practice Address - Country:US
Practice Address - Phone:518-793-4700
Practice Address - Fax:518-743-1061
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0001151225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant