Provider Demographics
NPI:1891306080
Name:KEANE, ALEXANDRA RADER (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RADER
Last Name:KEANE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:LAUREN
Other - Last Name:RADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1635 CREEKSIDE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3830
Mailing Address - Country:US
Mailing Address - Phone:916-983-5611
Mailing Address - Fax:916-983-5615
Practice Address - Street 1:1635 CREEKSIDE DR STE 101
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3830
Practice Address - Country:US
Practice Address - Phone:916-983-5611
Practice Address - Fax:916-983-5615
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist