Healthcare Provider Details

I. General information

NPI: 1669591830
Provider Name (Legal Business Name): ALFRED GEORGI PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 E SEMORAN BLVD STE 107
APOPKA FL
32703-5610
US

IV. Provider business mailing address

508 ORANGE DR APT 20
ALTAMONTE SPRINGS FL
32701-5350
US

V. Phone/Fax

Practice location:
  • Phone: 407-880-7772
  • Fax: 407-880-0893
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA17143
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: