Provider Demographics
NPI:1710359930
Name:WEIL, ALISON (MSPT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:WEIL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 GRAFFIN DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5607
Mailing Address - Country:US
Mailing Address - Phone:518-573-0515
Mailing Address - Fax:
Practice Address - Street 1:17 GRAFFIN DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5607
Practice Address - Country:US
Practice Address - Phone:518-573-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022036-1225100000X
MA25821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist