Healthcare Provider Details

I. General information

NPI: 1104763770
Provider Name (Legal Business Name): AALIYAH DE'JON MCCRARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 MERRIMAC AVE
JACKSONVILLE FL
32210-1814
US

IV. Provider business mailing address

980 SYLVAN AVE
ENGLEWOOD CLIFFS NJ
07632-3315
US

V. Phone/Fax

Practice location:
  • Phone: 904-389-5959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA32178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: