Provider Demographics
NPI:1124791652
Name:BAO, ALEX YANG (DPT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:YANG
Last Name:BAO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 AVIARA LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-6115
Mailing Address - Country:US
Mailing Address - Phone:513-504-7911
Mailing Address - Fax:
Practice Address - Street 1:9685 LAKE NONA VILLAGE PL STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7322
Practice Address - Country:US
Practice Address - Phone:407-914-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist