Provider Demographics
NPI:1114329315
Name:KOSHEFSKY, ALEX DANIEL
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:DANIEL
Last Name:KOSHEFSKY
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 1:4377 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1963
Mailing Address - Country:US
Mailing Address - Phone:352-684-6424
Mailing Address - Fax:352-684-6423
Practice Address - Street 1:4212 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2325
Practice Address - Country:US
Practice Address - Phone:325-684-6424
Practice Address - Fax:352-684-6423
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA25062225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant