Provider Demographics
NPI:1275909343
Name:SPATA, ALEXANDRA (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:SPATA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7269
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-373-1050
Practice Address - Fax:502-373-1051
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209760225100000X
KY006813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist