Provider Demographics
NPI:1619192457
Name:BAGLEY, ALEXANDER CHARLES (PT)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:CHARLES
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 YORK AVE
Mailing Address - Street 2:APT 1-P
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-7814
Mailing Address - Country:US
Mailing Address - Phone:646-546-5359
Mailing Address - Fax:212-746-7262
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4870
Practice Address - Country:US
Practice Address - Phone:212-746-1579
Practice Address - Fax:212-746-7262
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist