Provider Demographics
NPI:1275391187
Name:CISAR, ALEXANDREA DANIELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDREA
Middle Name:DANIELLE
Last Name:CISAR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31124 CAROUSEL LN UNIT 11204
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-5449
Mailing Address - Country:US
Mailing Address - Phone:410-804-8569
Mailing Address - Fax:
Practice Address - Street 1:900 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3604
Practice Address - Country:US
Practice Address - Phone:302-629-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist