Provider Demographics
NPI:1346504842
Name:ALEXANDER, MARISSA SUE (DPT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:SUE
Last Name:ALEXANDER
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 1:5767 S 5100 W
Mailing Address - Street 2:
Mailing Address - City:HOOPER
Mailing Address - State:UT
Mailing Address - Zip Code:84315-9514
Mailing Address - Country:US
Mailing Address - Phone:801-644-8556
Mailing Address - Fax:
Practice Address - Street 1:115 E TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-4319
Practice Address - Country:US
Practice Address - Phone:806-244-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3112266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist