Provider Demographics
NPI:1679773717
Name:ALEXANDER, JONATHAN TODD (PT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:TODD
Last Name:ALEXANDER
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 1:770 OAK GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-9441
Mailing Address - Country:US
Mailing Address - Phone:270-365-2011
Mailing Address - Fax:270-365-9433
Practice Address - Street 1:101 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-2301
Practice Address - Country:US
Practice Address - Phone:270-365-2011
Practice Address - Fax:270-365-9433
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT-003041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist