Provider Demographics
NPI:1982386900
Name:KEAR, ALEXANDRA MAE
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MAE
Last Name:KEAR
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 1:811 WHIPPLE AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2949
Mailing Address - Country:US
Mailing Address - Phone:719-285-5029
Mailing Address - Fax:
Practice Address - Street 1:722 S 8TH ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-4906
Practice Address - Country:US
Practice Address - Phone:719-345-4097
Practice Address - Fax:719-249-1516
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015401225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant