Provider Demographics
NPI:1689746679
Name:ALEXANDER, LINDA REEVES (DPT, OCS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:REEVES
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1627 WOODS CT
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2915
Practice Address - Country:US
Practice Address - Phone:541-386-9511
Practice Address - Fax:866-860-8070
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORJ5366-02OtherPACIFICSOURCE HEALTH PLAN
OR023088Medicaid
ORJ5366-02OtherPACIFICSOURCE HEALTH PLAN