MEDICARE: ALEX PLEIN P.T.A., B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	P160666575	WA

General Provider Information

NPI Number	:	1952841116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX PLEIN P.T.A., B.S.

Provider Business Mailing Address
First Line	:	5314 RIVER RUN DR STE 140
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-7706
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5314 RIVER RUN DR STE 140
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-7706
Country	:	US
Telephone Number	:	801-426-4905
Fax Number	:	801-426-4953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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