Provider Demographics
NPI:1285289538
Name:DICKENS, ALYSSA (PT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DICKENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 HOLLYWOOD BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6420
Mailing Address - Country:US
Mailing Address - Phone:954-603-1881
Mailing Address - Fax:954-603-5341
Practice Address - Street 1:5555 HOLLYWOOD BLVD STE 201
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6420
Practice Address - Country:US
Practice Address - Phone:954-603-1881
Practice Address - Fax:954-603-5341
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist