Provider Demographics
NPI:1255766705
Name:DECIRCE, ALISON ROSE (DPT)
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:ROSE
Last Name:DECIRCE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8788 FAIRBROOK CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2082
Mailing Address - Country:US
Mailing Address - Phone:607-206-5938
Mailing Address - Fax:
Practice Address - Street 1:8788 FAIRBROOK CT
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2082
Practice Address - Country:US
Practice Address - Phone:607-206-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT28618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist