Provider Demographics
NPI:1548299357
Name:ALEXANDER, BEATA T (PT)
Entity type:Individual
Prefix:
First Name:BEATA
Middle Name:T
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:1)PATRICIA 2)BEATA
Other - Middle Name:1) ANN
Other - Last Name:1)MORENO 2) MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4031 SE HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5243
Mailing Address - Country:US
Mailing Address - Phone:503-246-8282
Mailing Address - Fax:503-231-6605
Practice Address - Street 1:4031 SE HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5243
Practice Address - Country:US
Practice Address - Phone:503-246-8282
Practice Address - Fax:503-231-6605
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116217OtherMEDICARE GROUP NUMBER
OR116217OtherMEDICARE GROUP NUMBER