Healthcare Provider Details

I. General information

NPI: 1508121831
Provider Name (Legal Business Name): ALLISON GELUSO ITDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S ALAFAYA TRL # 101
ORLANDO FL
32828-8926
US

IV. Provider business mailing address

1525 S ALAFAYA TRL SUITE 101
ORLANDO FL
32828-8926
US

V. Phone/Fax

Practice location:
  • Phone: 407-340-4167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: