Healthcare Provider Details

I. General information

NPI: 1174778427
Provider Name (Legal Business Name): ALEKSANDAR OBRENOVIC DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2008
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 POND APPLE RD
BOCA RATON FL
33433-1930
US

IV. Provider business mailing address

6611 POND APPLE RD
BOCA RATON FL
33433-1930
US

V. Phone/Fax

Practice location:
  • Phone: 561-866-2345
  • Fax:
Mailing address:
  • Phone: 561-866-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: