Provider Demographics
NPI:1043975154
Name:CULICAN, ALEXANDRA (PT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:CULICAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-9007
Mailing Address - Country:US
Mailing Address - Phone:770-912-3573
Mailing Address - Fax:
Practice Address - Street 1:1823 N BROWN RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8121
Practice Address - Country:US
Practice Address - Phone:404-846-0899
Practice Address - Fax:404-351-5308
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist