Provider Demographics
NPI:1134306137
Name:RICHARD N ALEXANDER
Entity Type:Organization
Organization Name:RICHARD N ALEXANDER
Other - Org Name:EMERALD BAY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-570-0510
Mailing Address - Street 1:812 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6413
Mailing Address - Country:US
Mailing Address - Phone:530-542-2662
Mailing Address - Fax:530-542-2661
Practice Address - Street 1:812 EMERALD BAY RD
Practice Address - Street 2:
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6413
Practice Address - Country:US
Practice Address - Phone:530-542-2662
Practice Address - Fax:530-542-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty