Provider Demographics
NPI:1801368089
Name:BRODY, ALEX ROBERT
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:ROBERT
Last Name:BRODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1628
Mailing Address - Country:US
Mailing Address - Phone:636-208-1587
Mailing Address - Fax:
Practice Address - Street 1:400 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1628
Practice Address - Country:US
Practice Address - Phone:636-208-1587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer