Healthcare Provider Details

I. General information

NPI: 1023447109
Provider Name (Legal Business Name): ALYSSA HURLESS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17419 BRIDGE HILL CT
TAMPA FL
33647-3599
US

IV. Provider business mailing address

17419 BRIDGE HILL CT
TAMPA FL
33647-3599
US

V. Phone/Fax

Practice location:
  • Phone: 813-907-7879
  • Fax:
Mailing address:
  • Phone: 813-907-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28420
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: