=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730988817
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEX PT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2025
-----------------------------------------------------
Last Update Date | 08/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 591 NORTHSIDE DR SUITE 200
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56308-5578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-445-0100
-----------------------------------------------------
Fax | 320-445-0098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 591 NORTHSIDE DR SUITE 200
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56308-5578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-445-0100
-----------------------------------------------------
Fax | 320-445-0098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | JACOB CRUZE
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 651-283-6894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------