Provider Demographics
NPI:1457592636
Name:SEBBEN, ALEXANDER R (PT)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:R
Last Name:SEBBEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2328 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1459
Mailing Address - Country:US
Mailing Address - Phone:239-573-1518
Mailing Address - Fax:239-573-7356
Practice Address - Street 1:4316 LEE BLVD
Practice Address - Street 2:#12B
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1735
Practice Address - Country:US
Practice Address - Phone:239-368-7744
Practice Address - Fax:239-368-7814
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686520OtherMEDICARE GROUP
FLK0865OtherMEDICARE GROUP