Provider Demographics
NPI:1467719245
Name:ESPEDIDO, ALVIN IGNACIO BARCENAS (PT)
Entity Type:Individual
Prefix:MR
First Name:ALVIN IGNACIO
Middle Name:BARCENAS
Last Name:ESPEDIDO
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 1:347 PORTA ROSA CIR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-4760
Mailing Address - Country:US
Mailing Address - Phone:386-538-6913
Mailing Address - Fax:
Practice Address - Street 1:6050 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6860
Practice Address - Country:US
Practice Address - Phone:386-312-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist