Provider Demographics
NPI:1457787574
Name:ALEXANDER, LISA V (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:V
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 DEAN DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1616
Mailing Address - Country:US
Mailing Address - Phone:404-808-1328
Mailing Address - Fax:404-846-0886
Practice Address - Street 1:2221 PEACHTREE RD NE
Practice Address - Street 2:SUITE D336
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1148
Practice Address - Country:US
Practice Address - Phone:404-846-0886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist