Provider Demographics
NPI:1447386156
Name:PEREDA, ALEX (PT)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:PEREDA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7860 SW 129TH TER
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6154
Mailing Address - Country:US
Mailing Address - Phone:305-274-3311
Mailing Address - Fax:305-274-1411
Practice Address - Street 1:8585 SUNSET DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3746
Practice Address - Country:US
Practice Address - Phone:305-274-3311
Practice Address - Fax:305-274-1411
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT166222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic