Healthcare Provider Details

I. General information

NPI: 1720558133
Provider Name (Legal Business Name): ALEXIS HINGLE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35095 US HIGHWAY 19 N STE 101
PALM HARBOR FL
34684-1968
US

IV. Provider business mailing address

3903 NORTHDALE BLVD STE 111W
TAMPA FL
33624-1853
US

V. Phone/Fax

Practice location:
  • Phone: 727-475-5538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT34195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: