Provider Demographics
NPI:1376065532
Name:IMMERMANN, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:IMMERMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5152 HOLLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2550
Mailing Address - Country:US
Mailing Address - Phone:805-681-9108
Mailing Address - Fax:
Practice Address - Street 1:5152 HOLLISTER AVE
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93111-2550
Practice Address - Country:US
Practice Address - Phone:805-681-9108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty