Provider Demographics
NPI:1518157874
Name:MUKNICKA, ALESSANDRO ALPHA (LMT,CPT)
Entity Type:Individual
Prefix:
First Name:ALESSANDRO
Middle Name:ALPHA
Last Name:MUKNICKA
Suffix:
Gender:M
Credentials:LMT,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 NW 50TH DR APT 101
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7674
Mailing Address - Country:US
Mailing Address - Phone:352-246-8429
Mailing Address - Fax:
Practice Address - Street 1:4408 NW 36TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7215
Practice Address - Country:US
Practice Address - Phone:352-246-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 46102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist