Healthcare Provider Details

I. General information

NPI: 1457146094
Provider Name (Legal Business Name): ANDREA CECILE ALEXANDER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 E COURT ST
PARIS IL
61944-2460
US

IV. Provider business mailing address

721 E COURT ST
PARIS IL
61944-2460
US

V. Phone/Fax

Practice location:
  • Phone: 812-201-7161
  • Fax: 217-466-4057
Mailing address:
  • Phone: 812-201-7161
  • Fax: 217-466-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.004810
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: