Provider Demographics
NPI:1699240523
Name:ALEXANDER, DIDIER (PT,DPT)
Entity type:Individual
Prefix:DR
First Name:DIDIER
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SE TIFFANY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7576
Mailing Address - Country:US
Mailing Address - Phone:772-732-0000
Mailing Address - Fax:
Practice Address - Street 1:1701 SE TIFFANY AVE STE 102
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7576
Practice Address - Country:US
Practice Address - Phone:772-732-0000
Practice Address - Fax:772-732-3135
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-07
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty