Healthcare Provider Details

I. General information

NPI: 1457890485
Provider Name (Legal Business Name): TERRY ALVARADO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRY FLANIGAN

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10660 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32257-1076
US

IV. Provider business mailing address

PO BOX 1975
ROME GA
30162-1975
US

V. Phone/Fax

Practice location:
  • Phone: 904-619-5831
  • Fax: 866-225-4350
Mailing address:
  • Phone: 904-619-5831
  • Fax: 866-225-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA11944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: