Provider Demographics
NPI:1013071893
Name:ALEXANDER, SAMUEL LAZARUS (RPT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:LAZARUS
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40761 DEER PINES DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2233
Mailing Address - Country:US
Mailing Address - Phone:734-934-4537
Mailing Address - Fax:
Practice Address - Street 1:10501 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3375
Practice Address - Country:US
Practice Address - Phone:313-544-1400
Practice Address - Fax:313-483-0585
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist