Provider Demographics
NPI:1053915181
Name:SAXTON MEDINA, ALEJANDRO MOISES
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:MOISES
Last Name:SAXTON MEDINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9113 AVALON GATES
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5826
Mailing Address - Country:US
Mailing Address - Phone:973-525-0500
Mailing Address - Fax:
Practice Address - Street 1:9113 AVALON GATES
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5826
Practice Address - Country:US
Practice Address - Phone:973-525-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.012780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT14.012780OtherSTATE LICENSE NUMBER