Provider Demographics
NPI:1366485666
Name:ALEXANDER, JESSICA RENNIE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:RENNIE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:36 BARBER FARM RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465
Mailing Address - Country:US
Mailing Address - Phone:802-899-3726
Mailing Address - Fax:802-899-5549
Practice Address - Street 1:150 KENNEDY DR
Practice Address - Street 2:HOEPPNER PT
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-862-4670
Practice Address - Fax:802-862-4670
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT0400002533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT200050420OtherMVP
VTOVN2099Medicaid
VT566686900OtherCIGNA
VT200050420OtherMVP