Provider Demographics
NPI:1740708437
Name:ALDERDYCE, ALEX (PTA)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:ALDERDYCE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 QUAIL TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-4810
Mailing Address - Country:US
Mailing Address - Phone:319-540-0314
Mailing Address - Fax:
Practice Address - Street 1:4700 TAMA ST SE STE 700
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4558
Practice Address - Country:US
Practice Address - Phone:319-447-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082859225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant