Provider Demographics
NPI:1033341706
Name:JAFRATE, ALLY (PTA)
Entity Type:Individual
Prefix:
First Name:ALLY
Middle Name:
Last Name:JAFRATE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13506 SUMMERPORT VILLAGE PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7366
Mailing Address - Country:US
Mailing Address - Phone:321-266-8065
Mailing Address - Fax:
Practice Address - Street 1:13506 SUMMERPORT VILLAGE PKWY
Practice Address - Street 2:SUITE 410
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-7366
Practice Address - Country:US
Practice Address - Phone:407-905-9300
Practice Address - Fax:407-905-9309
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21776225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1366698532OtherGROUP NPI
FL000362600Medicaid