Provider Demographics
NPI:1053732743
Name:KROHN, ALEXANDER LOUIS (PT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:LOUIS
Last Name:KROHN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2798 YULUPA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8570
Mailing Address - Country:US
Mailing Address - Phone:707-527-4001
Mailing Address - Fax:707-527-7167
Practice Address - Street 1:2798 YULUPA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8570
Practice Address - Country:US
Practice Address - Phone:707-527-4001
Practice Address - Fax:707-527-7167
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist