Provider Demographics
NPI:1588843189
Name:GARDUQUE, ALEXANDER CAGUIOA (RPT)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:CAGUIOA
Last Name:GARDUQUE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6218
Mailing Address - Country:US
Mailing Address - Phone:201-315-9830
Mailing Address - Fax:
Practice Address - Street 1:2041 W STATE ROAD 426
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8548
Practice Address - Country:US
Practice Address - Phone:407-365-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA00804200225100000X
FL35118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067683Medicare PIN