MEDICARE: ALEX BARONICH DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	09063R	LA

General Provider Information

NPI Number	:	1093129843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX BARONICH DPT

Provider Business Mailing Address
First Line	:	5923 MONTICELLO DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1940
Country	:	US
Telephone Number	:	334-356-6453
Fax Number	:	334-239-8126

Provider Business Practice Location Address
First Line	:	5923 MONTICELLO DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1940
Country	:	US
Telephone Number	:	334-356-6453
Fax Number	:	334-239-8126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	05/22/2020

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