Provider Demographics
NPI:1255304218
Name:ALEXANDER, L. BLAIR (MS, ATC/L)
Entity Type:Individual
Prefix:MR
First Name:L.
Middle Name:BLAIR
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MS, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 N LAKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1081
Mailing Address - Country:US
Mailing Address - Phone:812-332-9439
Mailing Address - Fax:
Practice Address - Street 1:2980 N LAKEWOOD CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1081
Practice Address - Country:US
Practice Address - Phone:812-332-9439
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000500A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer