Provider Demographics
NPI:1639678238
Name:ALLEVIATE SPINAL PAIN PHYSICAL THERAPY & REHABILITATION
Entity Type:Organization
Organization Name:ALLEVIATE SPINAL PAIN PHYSICAL THERAPY & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKY MARI
Authorized Official - Middle Name:BATINGANA
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:845-553-4607
Mailing Address - Street 1:24 BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-2108
Mailing Address - Country:US
Mailing Address - Phone:845-553-4607
Mailing Address - Fax:
Practice Address - Street 1:24 BRIDGE LN
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-2108
Practice Address - Country:US
Practice Address - Phone:845-553-4607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38891261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy