Provider Demographics
NPI:1336764034
Name:WONDERS, ALEXANDRIA DEANA (ATC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:DEANA
Last Name:WONDERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17921 EVERLONG DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-8272
Mailing Address - Country:US
Mailing Address - Phone:256-585-4557
Mailing Address - Fax:
Practice Address - Street 1:17921 EVERLONG DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-8272
Practice Address - Country:US
Practice Address - Phone:256-585-4557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL55582255A2300X
FLPT39953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer