Healthcare Provider Details

I. General information

NPI: 1417864406
Provider Name (Legal Business Name): ALEXANDRA GLEASON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 ROLLING HILLS PL
CANTON GA
30114-0901
US

IV. Provider business mailing address

137 ROLLING HILLS PL
CANTON GA
30114-0901
US

V. Phone/Fax

Practice location:
  • Phone: 804-651-8755
  • Fax:
Mailing address:
  • Phone: 804-651-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217988
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: