Provider Demographics
NPI:1720630577
Name:GILBERT, ALEXANDER L (ATC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:L
Last Name:GILBERT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 LADY SLIPPER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE LUZERNE
Mailing Address - State:NY
Mailing Address - Zip Code:12846-3941
Mailing Address - Country:US
Mailing Address - Phone:518-696-4728
Mailing Address - Fax:
Practice Address - Street 1:3450 HULL RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4144
Practice Address - Country:US
Practice Address - Phone:352-273-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL56812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer