Provider Demographics
NPI:1417278920
Name:ALEXANDER, KYLEE DEE (DPT)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:DEE
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 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:920 COUNTRY CLUB RD
Practice Address - Street 2:STE 210B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6024
Practice Address - Country:US
Practice Address - Phone:541-242-4172
Practice Address - Fax:541-242-4171
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500625683Medicaid
ORP01853459OtherRR MEDICARE
ORP01853459OtherRR MEDICARE
ORR190650Medicare PIN