Healthcare Provider Details

I. General information

NPI: 1528544426
Provider Name (Legal Business Name): ALISON FLYNN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 GRASSLANDS BLVD APT 113
LAKELAND FL
33803-5443
US

IV. Provider business mailing address

4911 WATERSTONE WAY
MULBERRY FL
33860-6587
US

V. Phone/Fax

Practice location:
  • Phone: 863-617-9400
  • Fax: 863-688-9858
Mailing address:
  • Phone: 863-670-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: