Provider Demographics
NPI:1417252065
Name:ALEXANDER, LANE (LMT, MMP)
Entity Type:Individual
Prefix:MR
First Name:LANE
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 HURSTBOURNE VILLAGE DR STE 700
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1849
Mailing Address - Country:US
Mailing Address - Phone:502-994-9096
Mailing Address - Fax:
Practice Address - Street 1:4800 SHERBURN LN
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4197
Practice Address - Country:US
Practice Address - Phone:502-994-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist