Healthcare Provider Details

I. General information

NPI: 1881203677
Provider Name (Legal Business Name): ALEXANDRA SHEARON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BOGIE HILLS DR
COLUMBIA MO
65201-2832
US

IV. Provider business mailing address

1250 CINNAMON HILL LN APT 104
COLUMBIA MO
65201-8096
US

V. Phone/Fax

Practice location:
  • Phone: 573-999-4925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2020016759
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: