Provider Demographics
NPI:1295368413
Name:SY, ALEXANDER (PTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:SY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:9564 WORTHINGTON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8205
Mailing Address - Country:US
Mailing Address - Phone:407-721-3558
Mailing Address - Fax:
Practice Address - Street 1:1275 W GRANADA BLVD STE 4B2
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8259
Practice Address - Country:US
Practice Address - Phone:386-615-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA298232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic