| Doctor Name: | ALEX BONGON SIAPNO |
| NPI Number: | 1891056529 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. |
| License Number: | 1215510 |
| Business Practice Address: | 3034 S Dupont Blvd. Smyrna, DE - 19977 |
| Business Phone Number: | 3026535085 |
| Business Fax Number: | |
| Mailing Address: | 11 Fairway Lakes Dr, Apt. E21 DOVER |
| State: | DE |
| Postal Code: | 199048266 |
| Phone Number: | 3057930568 |
| Fax Number: | |
| NPI Enumeration Date: | 05/29/2012 |
| NPI Last Update Date: | 05/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1215510 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |