Provider Demographics
NPI:1871818773
Name:LUMBRERA-SUMAGAYSAY, IRELINA SULLERA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:IRELINA
Middle Name:SULLERA
Last Name:LUMBRERA-SUMAGAYSAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:IRELINA
Other - Middle Name:SULLERA
Other - Last Name:LUMBRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5875 NIGHT WIND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078
Mailing Address - Country:US
Mailing Address - Phone:917-434-2949
Mailing Address - Fax:347-621-4524
Practice Address - Street 1:5875 NIGHT WIND CIRCLE
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078
Practice Address - Country:US
Practice Address - Phone:917-434-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032206-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist