Provider Demographics
NPI:1831664747
Name:THOMAS, ALEXANDR P (LMT)
Entity Type:Individual
Prefix:
First Name:ALEXANDR
Middle Name:P
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 WEATHERED ROCK RD APT 6
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-1829
Mailing Address - Country:US
Mailing Address - Phone:573-301-5656
Mailing Address - Fax:
Practice Address - Street 1:214 PRODO DR STE 103
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-3904
Practice Address - Country:US
Practice Address - Phone:573-301-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017044399225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist