Provider Demographics
NPI:1295353787
Name:ALEXANDER, AUSTIN B (DPT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:B
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24671 MONROE AVE BLDG C102
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9589
Mailing Address - Country:US
Mailing Address - Phone:951-200-3620
Mailing Address - Fax:951-200-5811
Practice Address - Street 1:25495 MEDICAL CENTER DR STE 304
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4904
Practice Address - Country:US
Practice Address - Phone:951-696-7474
Practice Address - Fax:951-696-7575
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist