Provider Demographics
NPI:1619736840
Name:CABRERA, ALICIA IVETTE (PTA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:IVETTE
Last Name:CABRERA
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 1:1021 WINDMILL GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7239
Mailing Address - Country:US
Mailing Address - Phone:321-418-2403
Mailing Address - Fax:
Practice Address - Street 1:5213 PIPER LN
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5465
Practice Address - Country:US
Practice Address - Phone:904-251-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32939225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant