Alex Wilburn, LPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

25880 Issued in FL

Practice address

1680 SW Saint Lucie West Blvd
Suite 202
Port St Lucie, FL 34986-1927

Phone

(772) 878-3322

Fax

(772) 878-5030

NPI assigned

Sep 18, 2015

Last updated

Sep 18, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442534400000",
    "number": "1649649724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 SW SAINT LUCIE WEST BLVD",
            "address_2": "SUITE 202",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861927",
            "telephone_number": "772-878-3322",
            "fax_number": "772-878-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 SW SAINT LUCIE WEST BLVD",
            "address_2": "SUITE 202",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861927",
            "telephone_number": "772-878-3322",
            "fax_number": "772-878-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBURN",
        "first_name": "ALEX",
        "name_prefix": "Mr.",
        "credential": "LPTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-18",
        "last_updated": "2015-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "25880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurel Ann White
• Shane Donald Whiteley, DC
• Wholistic Medicine Clin
• Wickshire Port St. Lucie
• Dennis Darnell Wideman II
• Brandon Matthew Wildermuth, PHARMD
• Stacey Wilfork, RN
• Taylor Wilhelm, DPT
• William Salcedo DPM PA
• Aisha J Williams

• Physical Therapy Assistant in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.