Provider Demographics
NPI:1720856099
Name:VITALE, ALEXANDRA JANE (DPT)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:JANE
Last Name:VITALE
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8599 A C SKINNER PKWY UNIT 4412
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0862
Mailing Address - Country:US
Mailing Address - Phone:239-537-1196
Mailing Address - Fax:
Practice Address - Street 1:8599 A C SKINNER PKWY UNIT 5303
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0865
Practice Address - Country:US
Practice Address - Phone:239-537-1196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist