MEDICARE: ALEXANDER GOYCOCHEA

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	225200000X	Physical Therapy Assistant	A8355	NC
2	225200000X	Physical Therapy Assistant	PTA23871	FL
3	225200000X	Physical Therapy Assistant	54078	CA

General Provider Information

NPI Number	:	1346588654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER GOYCOCHEA

Provider Business Mailing Address
First Line	:	702 NW TREEMONT AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1046
Country	:	US
Telephone Number	:	772-924-6112
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 NW TREEMONT AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1046
Country	:	US
Telephone Number	:	772-924-6112
Fax Number	:

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

Provider Enumeration Date	:	01/21/2013
Last Update Date	:	05/28/2025

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Directions to “ ALEXANDER GOYCOCHEA ” Practice Location

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