Provider Demographics
NPI:1548769862
Name:DANIEL, ALEXANDRA N (ATC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:N
Last Name:DANIEL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 PINE VILLAGE PL
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-8623
Mailing Address - Country:US
Mailing Address - Phone:678-524-3331
Mailing Address - Fax:
Practice Address - Street 1:SLU 10720, 900 A WEST UNIVERSITY
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70402-8623
Practice Address - Country:US
Practice Address - Phone:985-549-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3102892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer