Healthcare Provider Details

I. General information

NPI: 1356360242
Provider Name (Legal Business Name): MISS KATRINA ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD (117)
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

1619 OAKWOOD AVE
RICHMOND VA
23223-6823
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax: 804-675-5335
Mailing address:
  • Phone: 804-222-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: