=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093810335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIE G ALEXANDER MSED, ATC, CSCS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5151 PARK AVE
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06825-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-365-7672
-----------------------------------------------------
Fax | 203-365-4704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 SCOTT RD
-----------------------------------------------------
City | PROSPECT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06712-1337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-758-0350
-----------------------------------------------------
Fax | 203-365-4704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------