Provider Demographics
NPI:1013488063
Name:D'INNOCENZO, ALESSANDRO
Entity type:Individual
Prefix:
First Name:ALESSANDRO
Middle Name:
Last Name:D'INNOCENZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 ORIOLE CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8359
Mailing Address - Country:US
Mailing Address - Phone:561-346-1990
Mailing Address - Fax:
Practice Address - Street 1:935 MILITARY TRL STE 102
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7009
Practice Address - Country:US
Practice Address - Phone:561-748-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist