Healthcare Provider Details

I. General information

NPI: 1336077296
Provider Name (Legal Business Name): ALEC CHARLES HOTCHKISS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 EASTPARK BLVD
MADISON WI
53718-2002
US

IV. Provider business mailing address

N1839 CRESTWOOD RD
ANTIGO WI
54409-8960
US

V. Phone/Fax

Practice location:
  • Phone: 608-440-6400
  • Fax:
Mailing address:
  • Phone: 715-219-4716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4348-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: