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General NPI Number Information
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NPI Number | 1013565118
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Entity Type | Individual
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Provider Name | ALYSSA MICHAELA URTULA PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/01/2019
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Last Update Date | 09/01/2019
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Provider Practice Location Address
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Address Line | 5360 LINTON BLVD
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City | DELRAY BEACH
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State | FL
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Zip | 33484-6514
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Country | US
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Telephone | 561-495-3021
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Fax |
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Provider Business Mailing Address
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Address Line | 7299 NORWICH LN
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-8502
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Country | US
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Telephone | 561-374-0455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT34899
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License Number State | FL
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