Provider Demographics
NPI:1639653587
Name:ALEXANDER, LAURA MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1671 COUNTY ROAD 5 N
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9543
Mailing Address - Country:US
Mailing Address - Phone:937-539-0228
Mailing Address - Fax:937-355-9244
Practice Address - Street 1:1671 COUNTY ROAD 5 N
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9543
Practice Address - Country:US
Practice Address - Phone:937-539-0228
Practice Address - Fax:937-355-9244
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.007954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist