Provider Demographics
NPI:1194743674
Name:ALEXANDER, JOHN D (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4520 EXECUTIVE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3023
Mailing Address - Country:US
Mailing Address - Phone:858-535-1894
Mailing Address - Fax:858-535-1863
Practice Address - Street 1:4520 EXECUTIVE DR
Practice Address - Street 2:STE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3023
Practice Address - Country:US
Practice Address - Phone:858-535-1894
Practice Address - Fax:858-535-1863
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT22323225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT22313BOtherPPIN
W15730AMedicare ID - Type Unspecified