Provider Demographics
NPI:1033785407
Name:NADEAU, ALEXANDER NORMAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:NORMAN
Last Name:NADEAU
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 MARINERS FRY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5808
Mailing Address - Country:US
Mailing Address - Phone:207-436-5091
Mailing Address - Fax:
Practice Address - Street 1:2216 MARINERS FRY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5808
Practice Address - Country:US
Practice Address - Phone:207-436-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1033785407Medicaid