Provider Demographics
NPI:1922249697
Name:MOUSA, ALFRED F (DPT)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:F
Last Name:MOUSA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 N BENEVA RD
Mailing Address - Street 2:SUITE 707
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1397
Mailing Address - Country:US
Mailing Address - Phone:941-366-7475
Mailing Address - Fax:941-366-4920
Practice Address - Street 1:935 N BENEVA RD
Practice Address - Street 2:SUITE 707
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1397
Practice Address - Country:US
Practice Address - Phone:941-366-7475
Practice Address - Fax:941-366-4920
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist