Provider Demographics
NPI:1205714631
Name:VANDEGRIFT, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:VANDEGRIFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 SW MOCKINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2046
Mailing Address - Country:US
Mailing Address - Phone:772-453-6242
Mailing Address - Fax:
Practice Address - Street 1:931 SE OCEAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2425
Practice Address - Country:US
Practice Address - Phone:772-283-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT43664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist