1457592636 NPI number — MR. ALEXANDER R SEBBEN PT

Table of content: MR. ALEXANDER R SEBBEN PT (NPI 1457592636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457592636 NPI number — MR. ALEXANDER R SEBBEN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEBBEN
Provider First Name:
ALEXANDER
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457592636
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2328 HANCOCK BRIDGE PKWY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
CAPE CORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33990-1459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-573-1518
Provider Business Mailing Address Fax Number:
239-573-7356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4316 LEE BLVD
Provider Second Line Business Practice Location Address:
#12B
Provider Business Practice Location Address City Name:
LEHIGH ACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33971-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-368-7744
Provider Business Practice Location Address Fax Number:
239-368-7814
Provider Enumeration Date:
03/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT20164 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 686520 . This is a "MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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