Provider Demographics
NPI:1992359863
Name:FELLOWS, ALEXANDER LEONARD (ATC, LAT, MED)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:LEONARD
Last Name:FELLOWS
Suffix:
Gender:M
Credentials:ATC, LAT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2011
Mailing Address - Country:US
Mailing Address - Phone:903-434-8642
Mailing Address - Fax:
Practice Address - Street 1:2110 N EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2011
Practice Address - Country:US
Practice Address - Phone:903-434-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT65252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer