Provider Demographics
NPI:1861782419
Name:KOVACSIK, ALYSE BROOKE (DPT)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:BROOKE
Last Name:KOVACSIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALYSE
Other - Middle Name:BROOKE
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3 N ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-1823
Mailing Address - Country:US
Mailing Address - Phone:856-906-8048
Mailing Address - Fax:
Practice Address - Street 1:314 CENTRAL AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2005
Practice Address - Country:US
Practice Address - Phone:609-365-8499
Practice Address - Fax:609-365-8498
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-17
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01594100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist