Healthcare Provider Details

I. General information

NPI: 1538610845
Provider Name (Legal Business Name): ALEC JOSEPH PRIBULSKY MS, AT, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N SCENIC HWY
BABSON PARK FL
33827-9751
US

IV. Provider business mailing address

1201 N SCENIC HWY
BABSON PARK FL
33827-9751
US

V. Phone/Fax

Practice location:
  • Phone: 863-734-1502
  • Fax:
Mailing address:
  • Phone: 863-734-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT. 004278
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 4242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: