Basic Information
| Provider Information | |||||||||
| NPI: | 1780931972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STORK | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | LUCILLE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 PLEASANT STREET | ||||||||
| Address2: | SOUTH 2 ROOM 236 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152416228 | ||||||||
| FaxNumber: | 5152418685 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 E HICKMAN RD | ||||||||
| Address2: | |||||||||
| City: | WAUKEE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152162999 | ||||||||
| FaxNumber: | 5154719243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 004955 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.