Provider Demographics
NPI:1679516801
Name:UFBERG, ALEX (PT)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:UFBERG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11048 RENNARD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-2618
Mailing Address - Country:US
Mailing Address - Phone:215-671-8909
Mailing Address - Fax:215-671-0686
Practice Address - Street 1:11048 RENNARD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-2618
Practice Address - Country:US
Practice Address - Phone:215-671-8909
Practice Address - Fax:215-671-0686
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-002109-E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS-71935Medicare UPIN