Provider Demographics
NPI:1811216575
Name:POE, ALEXANDER VAUGHN (PT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:VAUGHN
Last Name:POE
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 1:36 PROFILE CIR
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1749
Mailing Address - Country:US
Mailing Address - Phone:603-233-3634
Mailing Address - Fax:
Practice Address - Street 1:36 PROFILE CIRCLE
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1749
Practice Address - Country:US
Practice Address - Phone:603-233-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist