Provider Demographics
NPI:1174778427
Name:OBRENOVIC, ALEKSANDAR (DPT)
Entity type:Individual
Prefix:
First Name:ALEKSANDAR
Middle Name:
Last Name:OBRENOVIC
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 POND APPLE RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1930
Mailing Address - Country:US
Mailing Address - Phone:561-866-2345
Mailing Address - Fax:
Practice Address - Street 1:6611 POND APPLE RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-1930
Practice Address - Country:US
Practice Address - Phone:561-866-2345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist