Provider Demographics
NPI:1013381193
Name:MALLONGA, BRITTANY (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:
Last Name:MALLONGA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1207
Mailing Address - Country:US
Mailing Address - Phone:607-759-0968
Mailing Address - Fax:
Practice Address - Street 1:1105 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1207
Practice Address - Country:US
Practice Address - Phone:607-759-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1210776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist