Provider Demographics
NPI:1992395370
Name:GUILLEN, ALEXANDRIA J (DPT)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:J
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8291 SW 172ND ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4766
Mailing Address - Country:US
Mailing Address - Phone:305-491-4007
Mailing Address - Fax:
Practice Address - Street 1:4200 LAGUNA ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1801
Practice Address - Country:US
Practice Address - Phone:305-446-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist