Provider Demographics
NPI:1245532795
Name:LOEBEL BERTONI, ALISON HEATHER (PT)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:HEATHER
Last Name:LOEBEL BERTONI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:HEATHER
Other - Last Name:LOEBEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:30 DOYLE ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2509
Mailing Address - Country:US
Mailing Address - Phone:516-408-8337
Mailing Address - Fax:
Practice Address - Street 1:25111 WELLER AVE
Practice Address - Street 2:PS 138
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2531
Practice Address - Country:US
Practice Address - Phone:718-528-9053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0232751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist