Basic Information
| Provider Information | |||||||||
| NPI: | 1548509128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEROCILLO | ||||||||
| FirstName: | ALEXANDER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5517 110TH AVE N | ||||||||
| Address2: | APT. H-107 | ||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337822241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272892150 | ||||||||
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| Address1: | 5517 110TH AVE N | ||||||||
| Address2: | APT. H-107 | ||||||||
| City: | PINELLAS PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337822241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272892150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2013 | ||||||||
| LastUpdateDate: | 02/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT9058 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.