Provider Demographics
NPI:1043947153
Name:DESHOMMES, ALEXIA (PT)
Entity Type:Individual
Prefix:
First Name:ALEXIA
Middle Name:
Last Name:DESHOMMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALEXIA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4756
Mailing Address - Country:US
Mailing Address - Phone:321-842-4810
Mailing Address - Fax:321-842-4809
Practice Address - Street 1:1111 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4756
Practice Address - Country:US
Practice Address - Phone:321-842-4810
Practice Address - Fax:321-842-4809
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FLPT388612251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist