Provider Demographics
NPI:1932616406
Name:WILSON, ALEXANDRA PFEFFERLE (DPT, PT, OCS, ATC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:PFEFFERLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPT, PT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LETOURNEAU CIRCLE
Mailing Address - Street 2:BLDG 90311
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544
Mailing Address - Country:US
Mailing Address - Phone:850-881-3913
Mailing Address - Fax:
Practice Address - Street 1:130 LETOURNEAU CIRCLE
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:90311
Practice Address - Country:US
Practice Address - Phone:850-881-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3000842251X0800X
225100000X
LA3060032255A2300X
FLPT381832251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer