Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 012015-1 | NY |
NPI | 1124263207 |
---|---|
Provider Name | Ms. Leigh Mondello |
First Address | Nanuet, NY 10954-3435 |
Second Address | Nanuet, NY 10954-3435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2008 |
Last Update Date | 03/12/2008 |