Healthcare Provider Details

I. General information

NPI: 1699471649
Provider Name (Legal Business Name): ALISON KAY CASTREJON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N LAKE HOWARD DR
WINTER HAVEN FL
33881
US

IV. Provider business mailing address

221 CHAMPIONS VUE LOOP UNIT 102
DAVENPORT FL
33897-4870
US

V. Phone/Fax

Practice location:
  • Phone: 863-875-3599
  • Fax:
Mailing address:
  • Phone: 863-370-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA32425
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: