Provider Demographics
NPI:1548033970
Name:ROSAMOND, ALYSSA LAURA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LAURA
Last Name:ROSAMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13990 BARTRAM PARK BLVD UNIT 2814
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5580
Mailing Address - Country:US
Mailing Address - Phone:904-814-0827
Mailing Address - Fax:
Practice Address - Street 1:13990 BARTRAM PARK BLVD UNIT 2814
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5580
Practice Address - Country:US
Practice Address - Phone:904-814-0827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist