Provider Demographics
NPI:1952991325
Name:WILLIS, ALEXANDER EDWARD (PT DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:EDWARD
Last Name:WILLIS
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7606 N UNION BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3850
Mailing Address - Country:US
Mailing Address - Phone:719-667-0666
Mailing Address - Fax:719-594-5658
Practice Address - Street 1:7606 N UNION BLVD STE 140
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3850
Practice Address - Country:US
Practice Address - Phone:719-667-0666
Practice Address - Fax:719-594-5658
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0017486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist