Provider Demographics
NPI:1922472828
Name:TUMULAK, ALYSSA INGRID (PT)
Entity Type:Individual
Prefix:MS
First Name:ALYSSA INGRID
Middle Name:
Last Name:TUMULAK
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 1:959 42ND ST
Mailing Address - Street 2:APT 1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1146
Mailing Address - Country:US
Mailing Address - Phone:347-988-8353
Mailing Address - Fax:
Practice Address - Street 1:959 42ND ST
Practice Address - Street 2:APT 1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1146
Practice Address - Country:US
Practice Address - Phone:347-988-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist