Provider Demographics
NPI:1457114555
Name:SANTOS, ALEXANDRA MELODY (PTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MELODY
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 DAMROSCH ST
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-1301
Mailing Address - Country:US
Mailing Address - Phone:702-858-5611
Mailing Address - Fax:
Practice Address - Street 1:2310 TALL PINES DR STE 220
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5349
Practice Address - Country:US
Practice Address - Phone:727-953-3635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant