Provider Demographics
NPI:1477066876
Name:GABOURY, ALEXANDRA ROSE (PTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ROSE
Last Name:GABOURY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 SW HIDDEN RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2004
Mailing Address - Country:US
Mailing Address - Phone:443-852-3453
Mailing Address - Fax:888-721-1997
Practice Address - Street 1:210 JUPITER LAKES BLVD STE 5101
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7183
Practice Address - Country:US
Practice Address - Phone:561-741-1876
Practice Address - Fax:888-721-1997
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27863225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant