Provider Demographics
NPI:1760509772
Name:MAHUSAY, JOHANNAH ALICANTE (PT)
Entity Type:Individual
Prefix:
First Name:JOHANNAH
Middle Name:ALICANTE
Last Name:MAHUSAY
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 1:28 CROSSGATE RD
Mailing Address - Street 2:APT.1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1206
Mailing Address - Country:US
Mailing Address - Phone:551-689-0505
Mailing Address - Fax:
Practice Address - Street 1:20 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1501
Practice Address - Country:US
Practice Address - Phone:973-736-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01080500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist