Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 5119 | AL |
Y | 2251S0007X | Physical Therapist - Sports | PTL-11118 | CO |
NPI | 1295009942 |
---|---|
Provider Name | Erik Daniel Alexander |
First Address | Boulder, CO 80304-3979 |
Second Address | Boulder, CO 80304-3979 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2012 |
Last Update Date | 28/02/2012 |