Provider Demographics
NPI:1548509128
Name:PEROCILLO, ALEXANDER
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:PEROCILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 110TH AVE N
Mailing Address - Street 2:APT. H-107
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2241
Mailing Address - Country:US
Mailing Address - Phone:727-289-2150
Mailing Address - Fax:
Practice Address - Street 1:5517 110TH AVE N
Practice Address - Street 2:APT. H-107
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2241
Practice Address - Country:US
Practice Address - Phone:727-289-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-03
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist