Active NPI
Alexandra Bialousow
- Physical Therapy Assistant
- Myrtle Beach, SC
National Provider Identifier
1295564516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 4597
- Practice address
- 3736 Robert Grissom Pkwy
Myrtle Beach, SC 29577-6405 - Phone
- (800) 304-7152
- NPI assigned
- Jul 26, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 4597 | SC | Primary |
Addresses
Primary practice location
3736 Robert Grissom Pkwy
Myrtle Beach, SC 29577-6405
Mailing address
3736 Robert Grissom Pkwy
Myrtle Beach, SC 29577-6405
Phone (843) 602-0289
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4597 | SC | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721952000000",
"number": "1295564516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3736 ROBERT GRISSOM PKWY",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295776405",
"telephone_number": "843-602-0289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3736 ROBERT GRISSOM PKWY",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295776405",
"telephone_number": "800-304-7152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BIALOUSOW",
"first_name": "ALEXANDRA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-26",
"last_updated": "2024-07-26",
"certification_date": "2024-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "SC",
"license": "4597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.