Individual
ALEX HOUGHTALEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1900 ROUTE 31, SUITE 12, MACEDON, NY 14502-8943
(315) 986-4655
Mailing address
1900 ROUTE 31, SUITE 12, MACEDON, NY 14502-8943
(315) 986-4655
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
039069
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039069
NYS LICENCE
NY
Enumeration date
09/16/2015
Last updated
09/16/2015
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