MEDICARE: MR. JONATHAN MICHAEL ALEXANDER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4689	SC
2	208100000X	Physical Medicine & Rehabilitation Physician	4689	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053486613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN MICHAEL ALEXANDER PT

Provider Business Mailing Address
First Line	:	501 FOREST LN
Second Line	:	SUITE A
City	:	CLEMSON
State	:	SC
Zip	:	29631-2621
Country	:	US
Telephone Number	:	864-722-0335
Fax Number	:	864-233-7844

Provider Business Practice Location Address
First Line	:	501 FOREST LN
Second Line	:	SUITE A
City	:	CLEMSON
State	:	SC
Zip	:	29631-2621
Country	:	US
Telephone Number	:	864-722-0335
Fax Number	:	864-233-7844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/27/2016

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