Provider Demographics
NPI:1114731742
Name:JONES, ALEXANDRA ELAINE (BS, AAS, LMT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELAINE
Last Name:JONES
Suffix:
Gender:F
Credentials:BS, AAS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 ROLLISTON RD # DOWN
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5137
Mailing Address - Country:US
Mailing Address - Phone:216-309-2580
Mailing Address - Fax:
Practice Address - Street 1:15620 DETROIT AVE STE 106
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3708
Practice Address - Country:US
Practice Address - Phone:216-309-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026607225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist