Individual
ALEXANDER RIVERA LEGRAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3350 W SOUTHPORT RD, KISSIMMEE, FL 34746-2706
(407) 860-0152
Mailing address
3350 W SOUTHPORT RD, KISSIMMEE, FL 34746-2706
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
PTA28455
FL
225200000X
Physical Therapy Assistant
Primary
PTA28455
FL
Other
Enumeration date
05/14/2018
Last updated
05/14/2018
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