Provider Demographics
NPI:1841903424
Name:ASTA, ALEXANDRA JILLIAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JILLIAN
Last Name:ASTA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 SW 122ND AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2803
Mailing Address - Country:US
Mailing Address - Phone:732-796-5993
Mailing Address - Fax:
Practice Address - Street 1:10189 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-7617
Practice Address - Country:US
Practice Address - Phone:954-577-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist