Provider Demographics
NPI:1043876287
Name:SOWELL, ALEXANDRIA TATE (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:TATE
Last Name:SOWELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:TATE
Other - Last Name:HANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 WEDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1448
Mailing Address - Country:US
Mailing Address - Phone:270-791-0613
Mailing Address - Fax:
Practice Address - Street 1:1110 WILKINSON TRCE STE 101
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3402
Practice Address - Country:US
Practice Address - Phone:270-418-3324
Practice Address - Fax:270-418-3326
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist