Healthcare Provider Details

I. General information

NPI: 1730965732
Provider Name (Legal Business Name): ALYSSA FERNANDEZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA MARIE ORRICO DPT

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 ALLENS LN STE 101
WILMINGTON NC
28403-3662
US

IV. Provider business mailing address

1721 ALLENS LN STE 101
WILMINGTON NC
28403-3662
US

V. Phone/Fax

Practice location:
  • Phone: 910-256-4442
  • Fax: 910-256-4443
Mailing address:
  • Phone: 910-256-4442
  • Fax: 910-256-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberP24167
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number051022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: