Provider Demographics
NPI:1396272837
Name:ROBITAILLE, ALEXANDER SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:SCOTT
Last Name:ROBITAILLE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:317-963-7068
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4638
Practice Address - Country:US
Practice Address - Phone:260-373-6454
Practice Address - Fax:260-373-6470
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11019956A208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation