Provider Demographics
NPI:1134114408
Name:PETZE, ALEXANDRA MARY (ATC CHES)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:MARY
Last Name:PETZE
Suffix:
Gender:F
Credentials:ATC CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3856 DOMINION MILL DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6452
Mailing Address - Country:US
Mailing Address - Phone:703-736-8393
Mailing Address - Fax:
Practice Address - Street 1:11921 FREEDOM DRIVE SUITE 550
Practice Address - Street 2:CIGNA HEALTHCARE
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-736-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer