MEDICARE: MRS. TAMARA BETH 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	1162002	TX

General Provider Information

NPI Number	:	1710174842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMARA BETH ALEXANDER PT

Provider Business Mailing Address
First Line	:	348 TURQUOISE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76131-3705
Country	:	US
Telephone Number	:	817-847-1429
Fax Number	:

Provider Business Practice Location Address
First Line	:	6621 DAN DANCIGER RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4905
Country	:	US
Telephone Number	:	817-292-6330
Fax Number	:

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

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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