Provider Demographics
NPI:1942858444
Name:ROSENBERG, ALYSSA (PT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14601 SW 29TH ST
Mailing Address - Street 2:STE 111
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4715
Mailing Address - Country:US
Mailing Address - Phone:954-391-9155
Mailing Address - Fax:
Practice Address - Street 1:14601 SW 29TH ST STE 111
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4715
Practice Address - Country:US
Practice Address - Phone:954-391-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty