Alexa Courtney Pellack

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

6949 Issued in FL

Practice address

1502 SW 50TH St Apt 304
Cape Coral, FL 33914-3459

Phone

(570) 730-1916

NPI assigned

Jul 13, 2021

Last updated

Jun 8, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1881266450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 SW 50TH ST APT 304",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339143459",
            "telephone_number": "570-730-1916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 SW 50TH ST APT 304",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339143459",
            "telephone_number": "570-730-1916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "131 Parks Memorial",
            "address_2": "CBX 64",
            "address_purpose": "LOCATION",
            "city": "Milledgeville",
            "state": "GA",
            "postal_code": "31061",
            "country_code": "US",
            "telephone_number": "478-445-4092",
            "fax_number": "478-445-1913",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELLACK",
        "first_name": "ALEXA",
        "middle_name": "COURTNEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "6949",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Athletic Trainer in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.