Provider Demographics
NPI:1952575268
Name:MEDALLA, JOYCE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:
Last Name:MEDALLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JOYCE MAGDALENE
Other - Middle Name:BERNAL
Other - Last Name:MANUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 SAINT ANNS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-2800
Mailing Address - Country:US
Mailing Address - Phone:718-292-0880
Mailing Address - Fax:718-292-5735
Practice Address - Street 1:600 SAINT ANNS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-2800
Practice Address - Country:US
Practice Address - Phone:718-292-0880
Practice Address - Fax:718-292-5735
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist