Healthcare Provider Details

I. General information

NPI: 1528856432
Provider Name (Legal Business Name): ALEXANDRIA GOLLIHER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 RIDGE RD S APT 50
LARGO FL
33778-1608
US

IV. Provider business mailing address

2131 RIDGE RD S APT 50
LARGO FL
33778-1608
US

V. Phone/Fax

Practice location:
  • Phone: 727-742-1879
  • Fax:
Mailing address:
  • Phone: 727-742-1879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPTA23742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: