Provider Demographics
NPI:1437699113
Name:ALEXANDER, ANN (PT, DPT, LAT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PT, DPT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17476 HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:MN
Mailing Address - Zip Code:56320
Mailing Address - Country:US
Mailing Address - Phone:320-247-0620
Mailing Address - Fax:
Practice Address - Street 1:688 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:MAHTOMEDI
Practice Address - State:MN
Practice Address - Zip Code:55115-1812
Practice Address - Country:US
Practice Address - Phone:651-429-9947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31492255A2300X
MN12322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer