Provider Demographics
NPI:1609584184
Name:DUMLAO, ELLAINE MARIE ASTON (PT)
Entity Type:Individual
Prefix:
First Name:ELLAINE MARIE
Middle Name:ASTON
Last Name:DUMLAO
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 1:3334 BARKER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6304
Mailing Address - Country:US
Mailing Address - Phone:646-881-9091
Mailing Address - Fax:
Practice Address - Street 1:3334 BARKER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6304
Practice Address - Country:US
Practice Address - Phone:646-881-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty