Provider Demographics
NPI:1922606805
Name:KOSTENKO, ALEXANDR JR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDR
Middle Name:
Last Name:KOSTENKO
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 LAMAR SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2209
Mailing Address - Country:US
Mailing Address - Phone:512-443-5777
Mailing Address - Fax:
Practice Address - Street 1:1339 LAMAR SQUARE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2209
Practice Address - Country:US
Practice Address - Phone:512-443-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1337221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist