Provider Demographics
NPI:1437467701
Name:ALMODOVAR, ELLEN MAY (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MAY
Last Name:ALMODOVAR
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 1:208 N KINGS AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3324
Mailing Address - Country:US
Mailing Address - Phone:516-795-8464
Mailing Address - Fax:
Practice Address - Street 1:208 N KINGS AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-3324
Practice Address - Country:US
Practice Address - Phone:516-795-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0108012251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics