MEDICARE: PAUL 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
2	225100000X	Physical Therapist	5501016364	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01045617	OTHER	IL	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1710265723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ALEXANDER PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 S TELEGRAPH RD
Second Line	:
City	:	BLOOMFIELD TOWNSHIP
State	:	MI
Zip	:	48302-0246
Country	:	US
Telephone Number	:	248-319-6180
Fax Number	:

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

Provider Enumeration Date	:	07/25/2011
Last Update Date	:	03/24/2021

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