Provider Demographics
NPI:1417676719
Name:SAMOILENKA, ALIAKSANDRA (PTA)
Entity Type:Individual
Prefix:
First Name:ALIAKSANDRA
Middle Name:
Last Name:SAMOILENKA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:SAMOILENKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:5521 HARBORSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-3666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1888 S PINELLAS AVE STE A
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1925
Practice Address - Country:US
Practice Address - Phone:727-934-6791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32198225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant