Provider Demographics
NPI:1275366908
Name:ACEVEDO, ALEJANDRO ANDRES (PTA)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ANDRES
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 NE 130TH ST FL 33161
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7526
Mailing Address - Country:US
Mailing Address - Phone:786-321-0796
Mailing Address - Fax:
Practice Address - Street 1:11241 W ATLANTIC BLVD APT 202
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5109
Practice Address - Country:US
Practice Address - Phone:954-260-9431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL321872251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics