Provider Demographics
NPI:1669874517
Name:COSTANTE, ALYSSA (PT, DPT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:COSTANTE
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 103RD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7733
Mailing Address - Country:US
Mailing Address - Phone:904-573-0046
Mailing Address - Fax:904-573-0772
Practice Address - Street 1:6248 103RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7733
Practice Address - Country:US
Practice Address - Phone:904-573-0046
Practice Address - Fax:904-573-0772
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL35952255A2300X
FLPT34054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer