Provider Demographics
NPI:1841652617
Name:VASYLENKO, ALYONA (LAT,ATC)
Entity type:Individual
Prefix:
First Name:ALYONA
Middle Name:
Last Name:VASYLENKO
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 S HAMPTON AT WATERFORD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-7868
Mailing Address - Country:US
Mailing Address - Phone:570-778-6534
Mailing Address - Fax:
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 290
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-812-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0061682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer