Provider Demographics
NPI:1255708020
Name:DUPOTEY, ALEJANDRO (PTA)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:DUPOTEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8748 NW 152ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1357
Mailing Address - Country:US
Mailing Address - Phone:786-546-1733
Mailing Address - Fax:
Practice Address - Street 1:8748 NW 152ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33018-1357
Practice Address - Country:US
Practice Address - Phone:786-546-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 25660225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant