Provider Demographics
NPI:1750832275
Name:DRAKE, ALEXANDER CHARLES (DPT)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:CHARLES
Last Name:DRAKE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 SHEPHERD CT
Mailing Address - Street 2:APARTMENT# 206
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5380
Mailing Address - Country:US
Mailing Address - Phone:908-642-1629
Mailing Address - Fax:
Practice Address - Street 1:1300 S GREEN BAY RD
Practice Address - Street 2:SUITE #205
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4469
Practice Address - Country:US
Practice Address - Phone:262-898-3930
Practice Address - Fax:262-898-3933
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13637-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist