Provider Demographics
NPI:1740273648
Name:ALESSANDRINO, MARY CLARE (MPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CLARE
Last Name:ALESSANDRINO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1624
Mailing Address - Country:US
Mailing Address - Phone:814-437-9750
Mailing Address - Fax:814-437-9757
Practice Address - Street 1:16269 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3887
Practice Address - Country:US
Practice Address - Phone:814-337-7606
Practice Address - Fax:814-337-2285
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012531L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1451392Medicare UPIN
PAP00142765Medicare UPIN