Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 4689 | SC |
Y | 225100000X | Physical Therapist | 4689 | SC |
NPI | 1053486613 |
---|---|
Provider Name | Mr. Jonathan Michael Alexander |
First Address | Clemson, SC 29631-2621 |
Second Address | Clemson, SC 29631-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 27/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TH3352 | (05) | SC |