MEDICARE: MRS. ALYSHA NICOLE MONDUORI DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 21631	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1043272461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALYSHA NICOLE MONDUORI DPT

Provider Business Mailing Address
First Line	:	614 WATERFORD CIR E
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34688-7211
Country	:	US
Telephone Number	:	352-870-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3890 TAMPA RD STE 303
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3677
Country	:	US
Telephone Number	:	727-787-5577
Fax Number	:	727-781-7757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	02/02/2021

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