Individual
ALISA DANGSUPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T., D.P.T.
Contact information
Practice address
3820 COLONIAL BLVD, SUITE 103, FORT MYERS, FL 33966-1094
(239) 275-4411
Mailing address
15340 WILL LEW LN, FORT MYERS, FL 33908-4247
(813) 431-2052
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
24639
FL
Other
Enumeration date
06/05/2009
Last updated
06/05/2009
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