Provider Demographics
NPI:1932639721
Name:HANNA, ALYSSA NICOLE MAGERKURTH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:NICOLE MAGERKURTH
Last Name:HANNA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 VALLANCE WAY NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3435
Mailing Address - Country:US
Mailing Address - Phone:908-227-0352
Mailing Address - Fax:
Practice Address - Street 1:2753 STATE ROAD 580 STE 111
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3351
Practice Address - Country:US
Practice Address - Phone:727-724-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL325852251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty