Provider Demographics
NPI:1922294974
Name:PETERS, ALEXANDRA MARIA (RPT)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:MARIA
Last Name:PETERS
Suffix:
Gender:F
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:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-0543
Mailing Address - Country:US
Mailing Address - Phone:813-244-1488
Mailing Address - Fax:813-986-4512
Practice Address - Street 1:11706 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:THONOTOSASSA
Practice Address - State:FL
Practice Address - Zip Code:33592-2948
Practice Address - Country:US
Practice Address - Phone:813-244-1488
Practice Address - Fax:813-986-4512
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist