Provider Demographics
NPI:1326514449
Name:ROSE, ALEXA D (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:D
Last Name:ROSE
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-0002
Mailing Address - Country:US
Mailing Address - Phone:336-226-0660
Mailing Address - Fax:336-227-6327
Practice Address - Street 1:1248 HUFFMAN MILL RD STE 200
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-226-0660
Practice Address - Fax:336-227-6327
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013724225100000X
NCP18402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist