Provider Demographics
NPI:1972998656
Name:ALTAMIRANO, LIESLY GUIMARAY
Entity Type:Individual
Prefix:MISS
First Name:LIESLY
Middle Name:GUIMARAY
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LIESLY
Other - Middle Name:RELANO
Other - Last Name:GUIMARAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:3213 HAMILTON WAY
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4957
Mailing Address - Country:US
Mailing Address - Phone:917-434-6357
Mailing Address - Fax:
Practice Address - Street 1:3717 111TH ST APT 2E
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3816
Practice Address - Country:US
Practice Address - Phone:917-434-6357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist