Healthcare Provider Details

I. General information

NPI: 1932656469
Provider Name (Legal Business Name): JOANNA ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SHIPPEE LN
SHARON VT
05065-0219
US

IV. Provider business mailing address

12 SHIPPEE LANE
SHARON VT
05065-0216
US

V. Phone/Fax

Practice location:
  • Phone: 802-763-8000
  • Fax: 802-763-8090
Mailing address:
  • Phone: 802-763-8000
  • Fax: 802-763-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number041.0123046
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1236
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: