Healthcare Provider Details

I. General information

NPI: 1336155407
Provider Name (Legal Business Name): DEBORAH SUSAN ALEXANDER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH SUSAN SCARLET

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 ORCHARD LAKE RD
KEEGO HARBOR MI
48320-1445
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 248-683-0185
  • Fax: 248-683-5692
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501001675
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: