Provider Demographics
NPI:1831507797
Name:ALEXANDER, ROBERTA (LMT)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1999 WESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1039
Mailing Address - Country:US
Mailing Address - Phone:847-623-2257
Mailing Address - Fax:
Practice Address - Street 1:1999 WESTFIELD DR
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1039
Practice Address - Country:US
Practice Address - Phone:847-623-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227002309225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist