Provider Demographics
NPI:1124702980
Name:POPE, ALEXANDER LEE
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:LEE
Last Name:POPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 N WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3559
Mailing Address - Country:US
Mailing Address - Phone:262-989-4017
Mailing Address - Fax:
Practice Address - Street 1:3665 N WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-3559
Practice Address - Country:US
Practice Address - Phone:262-989-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist