Provider Demographics
NPI:1275697591
Name:ALEXANDER, REBECCA KRISTIN (MSPT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:KRISTIN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NEW LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9540
Mailing Address - Country:US
Mailing Address - Phone:413-467-7089
Mailing Address - Fax:
Practice Address - Street 1:41 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4510
Practice Address - Country:US
Practice Address - Phone:413-733-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist