Provider Demographics
NPI:1417323577
Name:MACGEORGE, ALYSSA LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYNN
Last Name:MACGEORGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:336 BROAD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3006
Mailing Address - Country:US
Mailing Address - Phone:386-851-0901
Mailing Address - Fax:386-851-2426
Practice Address - Street 1:1565 SAXON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5836
Practice Address - Country:US
Practice Address - Phone:386-851-0901
Practice Address - Fax:386-851-2426
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT284692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic