Provider Demographics
NPI:1245567742
Name:ROSENTHAL, ALISHA NICHOLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:NICHOLE
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7995
Mailing Address - Country:US
Mailing Address - Phone:386-445-2589
Mailing Address - Fax:
Practice Address - Street 1:17 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-7995
Practice Address - Country:US
Practice Address - Phone:386-445-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55444172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist