Provider Demographics
NPI:1285874438
Name:HAILEMELEKOT, ALEXANDER DEMOZ (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:DEMOZ
Last Name:HAILEMELEKOT
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 13TH ST NE
Mailing Address - Street 2:APT. A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4412
Mailing Address - Country:US
Mailing Address - Phone:720-220-7610
Mailing Address - Fax:
Practice Address - Street 1:101 CENTENNIAL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5975
Practice Address - Country:US
Practice Address - Phone:301-392-3700
Practice Address - Fax:301-392-3876
Is Sole Proprietor?:No
Enumeration Date:2009-03-01
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22828172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist