Healthcare Provider Details

I. General information

NPI: 1669987251
Provider Name (Legal Business Name): ALEJANDRO CONCEPCION PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W 46TH ST
HIALEAH FL
33012-2835
US

IV. Provider business mailing address

1750 W 46TH ST 518
HIALEAH FL
33012-2835
US

V. Phone/Fax

Practice location:
  • Phone: 786-972-8370
  • Fax:
Mailing address:
  • Phone: 786-972-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number28106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: