Individual
VANNISA PELAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
475 NORTHERN BLVD, GREAT NECK, NY 11021-4819
(917) 968-8497
Mailing address
1072 ROGERS AVE APT 1, BROOKLYN, NY 11226-6221
(347) 586-1228
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
012703-01
NY
Other
Enumeration date
10/27/2021
Last updated
10/27/2021
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