Provider Demographics
NPI:1508403932
Name:ALEXANDER, KEVIN SR (LMT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:ALEXANDER
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 MAIN ST STE 108
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2606
Mailing Address - Country:US
Mailing Address - Phone:605-391-3788
Mailing Address - Fax:
Practice Address - Street 1:916 MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2606
Practice Address - Country:US
Practice Address - Phone:605-391-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist