Provider Demographics
NPI:1851057962
Name:GADDIE, ALEXANDER LEE (PTA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:LEE
Last Name:GADDIE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42134-1560
Mailing Address - Country:US
Mailing Address - Phone:270-218-1300
Mailing Address - Fax:
Practice Address - Street 1:139 PEARL ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-5121
Practice Address - Country:US
Practice Address - Phone:270-542-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03965225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant