Provider Demographics
NPI:1679822183
Name:HERZLIN, ALEXANDER DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:DAVID
Last Name:HERZLIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 FAU BLVD 105
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:561-395-2920
Mailing Address - Fax:561-997-8929
Practice Address - Street 1:3848 FAU BLVD 105
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:561-395-2920
Practice Address - Fax:561-997-8929
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010798225100000X
FLPT30157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist