Provider Demographics
NPI:1205116324
Name:CHURCHILL, ALISHA M (PT)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:M
Last Name:CHURCHILL
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:COVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:8557 PILGRIM CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6608
Mailing Address - Country:US
Mailing Address - Phone:813-476-8810
Mailing Address - Fax:
Practice Address - Street 1:2701 PARK DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1021
Practice Address - Country:US
Practice Address - Phone:727-292-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist