Healthcare Provider Details

I. General information

NPI: 1205793692
Provider Name (Legal Business Name): JANDY NICOLE LIRIANO ALVAREZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SILVERMINE RD STE 300
BROOKFIELD CT
06804-2047
US

IV. Provider business mailing address

12281 LEXINGTON PARK DR
TAMPA FL
33626-2730
US

V. Phone/Fax

Practice location:
  • Phone: 888-374-0855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA32978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: