1538855523 NPI number — ALEXANDRA KROHNFELDT DUVAL DPT

Table of content: ALEXANDRA KROHNFELDT DUVAL DPT (NPI 1538855523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538855523 NPI number — ALEXANDRA KROHNFELDT DUVAL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUVAL
Provider First Name:
ALEXANDRA
Provider Middle Name:
KROHNFELDT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

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:
1538855523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 MARINER HEALTH WAY STE 213
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32086-3251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-217-4259
Provider Business Mailing Address Fax Number:
904-217-4251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 MARINER HEALTH WAY STE 213
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32086-3251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-217-4259
Provider Business Practice Location Address Fax Number:
904-217-4251
Provider Enumeration Date:
04/13/2023

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:  PT39945 , 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)





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