1306430277 NPI number — MICHAELA ALVENA TROISI DPT, ATC

Table of content: MICHAELA ALVENA TROISI DPT, ATC (NPI 1306430277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306430277 NPI number — MICHAELA ALVENA TROISI DPT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROISI
Provider First Name:
MICHAELA
Provider Middle Name:
ALVENA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KONZMAN
Provider Other First Name:
MICHAELA
Provider Other Middle Name:
ALVENA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306430277
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 NEW FIDELITY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-842-9323
Provider Business Mailing Address Fax Number:
570-587-1978

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 WILLOW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-219-4600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT029315 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT029315 . This is a "DEPARTMENT OF STATE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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