MEDICARE: ALEXA DESANTIS PT, 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	225100000X	Physical Therapist	40QA02308100	NJ

General Provider Information

NPI Number	:	1558170803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA DESANTIS PT, DPT

Provider Business Mailing Address
First Line	:	160 WHITE RD STE 104
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1167
Country	:	US
Telephone Number	:	732-383-8295
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 WHITE RD STE 104
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1167
Country	:	US
Telephone Number	:	732-383-8295
Fax Number	:

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

Provider Enumeration Date	:	01/02/2025
Last Update Date	:	01/02/2025

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