Provider Demographics
NPI:1205089836
Name:STANISLAUS, ALTHEA B II
Entity type:Individual
Prefix:
First Name:ALTHEA
Middle Name:B
Last Name:STANISLAUS
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 RIVERSIDE DR
Mailing Address - Street 2:SUITE #4
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2732
Mailing Address - Country:US
Mailing Address - Phone:607-798-8800
Mailing Address - Fax:
Practice Address - Street 1:108 RYANS WAY
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-1551
Practice Address - Country:US
Practice Address - Phone:315-491-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030616-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist