Provider Demographics
NPI:1073999611
Name:KORMAN, ALEXANDER JEROD (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JEROD
Last Name:KORMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LIFE WAY
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-6540
Mailing Address - Country:US
Mailing Address - Phone:828-627-5433
Mailing Address - Fax:828-627-8888
Practice Address - Street 1:251 SHELTON ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3362
Practice Address - Country:US
Practice Address - Phone:828-627-5433
Practice Address - Fax:828-627-8888
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist