Provider Demographics
NPI:1275547861
Name:ALEXANDER, KELLY (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:144 EVERGREEN PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-7056
Mailing Address - Country:US
Mailing Address - Phone:417-991-3440
Mailing Address - Fax:417-991-3445
Practice Address - Street 1:144 EVERGREEN PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-7056
Practice Address - Country:US
Practice Address - Phone:417-991-3440
Practice Address - Fax:417-991-3445
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO222241708Medicare PIN