Basic Information
| Provider Information | |||||||||
| NPI: | 1194100297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | TILLMAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 251 W CENTER ST | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275405900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195779200 | ||||||||
| FaxNumber: | 9195779292 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 W CENTER ST | ||||||||
| Address2: | |||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275405900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195779200 | ||||||||
| FaxNumber: | 9195779292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2015 | ||||||||
| LastUpdateDate: | 07/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P15785 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.