Healthcare Provider Details

I. General information

NPI: 1568153385
Provider Name (Legal Business Name): ALEXANDER MANOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SMITH AVE N STE 120
SAINT PAUL MN
55102-2579
US

IV. Provider business mailing address

2565 FRANKLIN AVE APT 404
SAINT PAUL MN
55114-3004
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-4977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: