Provider Demographics
NPI:1396551933
Name:TREGUBOFF, ALEXA
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:TREGUBOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10591 W ALEX AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-0507
Mailing Address - Country:US
Mailing Address - Phone:623-694-6098
Mailing Address - Fax:
Practice Address - Street 1:6630 W CACTUS RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1600
Practice Address - Country:US
Practice Address - Phone:623-469-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ033935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist