Provider Demographics
NPI:1518583566
Name:ALEXANDERS FITNESS COMPANY LLC
Entity Type:Organization
Organization Name:ALEXANDERS FITNESS COMPANY LLC
Other - Org Name:ALX FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:GRAFF
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-262-8486
Mailing Address - Street 1:1160 E 3900 S STE 4000
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1264
Mailing Address - Country:US
Mailing Address - Phone:801-262-8486
Mailing Address - Fax:
Practice Address - Street 1:245 S 1060 W
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1606
Practice Address - Country:US
Practice Address - Phone:385-306-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty