Provider Demographics
NPI:1710961115
Name:ALEXANDER, RICHARD N (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:N
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 1:812 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:S LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6413
Mailing Address - Country:US
Mailing Address - Phone:530-542-2662
Mailing Address - Fax:530-542-2661
Practice Address - Street 1:812 EMERALD BAY RD
Practice Address - Street 2:
Practice Address - City:S LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6413
Practice Address - Country:US
Practice Address - Phone:530-542-2662
Practice Address - Fax:530-542-2661
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 17203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT172030Medicare PIN