Provider Demographics
NPI:1518927987
Name:BUBECK, ALYSSA CAROL (DPT)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:CAROL
Last Name:BUBECK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 SEQUOIA TER
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-6560
Mailing Address - Country:US
Mailing Address - Phone:561-602-3128
Mailing Address - Fax:
Practice Address - Street 1:37026 US HIGHWAY 19 N
Practice Address - Street 2:ORTHOPEDIC SPECIALISTS
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-938-1935
Practice Address - Fax:727-937-7199
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist