Provider Demographics
NPI:1427652742
Name:MONTALVO, ALEX JAIME (PT)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JAIME
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24291 SW 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4006
Mailing Address - Country:US
Mailing Address - Phone:305-725-2462
Mailing Address - Fax:
Practice Address - Street 1:24291 SW 130TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4006
Practice Address - Country:US
Practice Address - Phone:305-725-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist