Provider Demographics
NPI:1841444536
Name:ZAGADO, ALICE (PT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:ZAGADO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-5003
Mailing Address - Country:US
Mailing Address - Phone:917-653-6357
Mailing Address - Fax:914-779-0929
Practice Address - Street 1:107 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-5003
Practice Address - Country:US
Practice Address - Phone:917-653-6357
Practice Address - Fax:914-779-0929
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist