Provider Demographics
NPI:1780163352
Name:HAIRR, ALEXA
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:HAIRR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-608-0865
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:1202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-2405
Practice Address - Country:US
Practice Address - Phone:252-447-4005
Practice Address - Fax:252-447-4001
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC080947OtherOPTUM