Provider Demographics
NPI:1801373204
Name:FOREMAN, ALEXANDRA RENAE ROOS (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:RENAE ROOS
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:RENAE
Other - Last Name:ROOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750-8947
Mailing Address - Country:US
Mailing Address - Phone:256-665-3114
Mailing Address - Fax:
Practice Address - Street 1:207 EUSTIS AVE SE STE B
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4275
Practice Address - Country:US
Practice Address - Phone:256-665-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist