Provider Demographics
NPI:1780345678
Name:FERONTI MAZZONI, ALYSSIA RAE (DPT)
Entity type:Individual
Prefix:
First Name:ALYSSIA
Middle Name:RAE
Last Name:FERONTI MAZZONI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSSIA
Other - Middle Name:RAE
Other - Last Name:FERONTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-5820
Mailing Address - Fax:
Practice Address - Street 1:220 S COURTENAY PKWY STE B
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4893
Practice Address - Country:US
Practice Address - Phone:321-434-5820
Practice Address - Fax:321-434-9125
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT609OtherMEDICARE