Provider Demographics
NPI:1669915740
Name:TENENHAUS, ALLISSA P (DPT, OCS, SCS)
Entity type:Individual
Prefix:
First Name:ALLISSA
Middle Name:P
Last Name:TENENHAUS
Suffix:
Gender:F
Credentials:DPT, OCS, SCS
Other - Prefix:
Other - First Name:ALLISSA
Other - Middle Name:P
Other - Last Name:FABRIKANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, OCS, SCS
Mailing Address - Street 1:573 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1010
Mailing Address - Country:US
Mailing Address - Phone:516-681-4567
Mailing Address - Fax:
Practice Address - Street 1:573 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1010
Practice Address - Country:US
Practice Address - Phone:516-681-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033461OtherPHYSICAL THERAPY