MEDICARE: ALEXANDRA LEA SCALLIONS DPT

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	225100000X	Physical Therapist	5223	AR

General Provider Information

NPI Number	:	1992481691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA LEA SCALLIONS DPT

Provider Business Mailing Address
First Line	:	9701 MUIRFIELD CIR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-0716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 ROGERS AVE # F
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-2006
Country	:	US
Telephone Number	:	479-719-9392
Fax Number	:

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

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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