Provider Demographics
NPI:1538610845
Name:PRIBULSKY, ALEC JOSEPH (MS, AT, LAT)
Entity type:Individual
Prefix:
First Name:ALEC
Middle Name:JOSEPH
Last Name:PRIBULSKY
Suffix:
Gender:M
Credentials:MS, AT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:BABSON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33827-9751
Mailing Address - Country:US
Mailing Address - Phone:863-734-1502
Mailing Address - Fax:
Practice Address - Street 1:1201 N SCENIC HWY
Practice Address - Street 2:
Practice Address - City:BABSON PARK
Practice Address - State:FL
Practice Address - Zip Code:33827-9751
Practice Address - Country:US
Practice Address - Phone:863-734-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT. 0042782255A2300X
FLAL 42422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer