Healthcare Provider Details

I. General information

NPI: 1114329315
Provider Name (Legal Business Name): MR. ALEX DANIEL KOSHEFSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 COMMERCIAL WAY
SPRING HILL FL
34606-2325
US

IV. Provider business mailing address

4377 COMMERCIAL WAY
SPRING HILL FL
34606-1963
US

V. Phone/Fax

Practice location:
  • Phone: 325-684-6424
  • Fax: 352-684-6423
Mailing address:
  • Phone: 352-684-6424
  • Fax: 352-684-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA25062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: