Provider Demographics
NPI:1831384320
Name:KALLENOS, ALYSSA STACEY (PT)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:STACEY
Last Name:KALLENOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:STACEY
Other - Last Name:OKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1336 50TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3501
Mailing Address - Country:US
Mailing Address - Phone:718-435-6906
Mailing Address - Fax:718-435-6908
Practice Address - Street 1:1336 50TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3501
Practice Address - Country:US
Practice Address - Phone:718-435-6906
Practice Address - Fax:718-435-6908
Is Sole Proprietor?:No
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014446-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist