Provider Demographics
NPI: | 1437552585 |
---|---|
Name: | KOCHEL, ALEXANDRA M (DPT, PT) |
Entity Type: | Individual |
Prefix: | |
First Name: | ALEXANDRA |
Middle Name: | M |
Last Name: | KOCHEL |
Suffix: | |
Gender: | F |
Credentials: | DPT, PT |
Other - Prefix: | |
Other - First Name: | ALEXANDRA |
Other - Middle Name: | M |
Other - Last Name: | SCHOENER |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | DPT, PT |
Mailing Address - Street 1: | 1 CREDIT UNION WAY |
Mailing Address - Street 2: | FL. 3 |
Mailing Address - City: | RANDOLPH |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02368-4633 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 781-961-3370 |
Mailing Address - Fax: | 781-961-1291 |
Practice Address - Street 1: | 300 ELMWOOD ST |
Practice Address - Street 2: | |
Practice Address - City: | N ATTLEBORO |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02760-1304 |
Practice Address - Country: | US |
Practice Address - Phone: | 508-695-2280 |
Practice Address - Fax: | 508-695-2298 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2014-10-03 |
Last Update Date: | 2018-03-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | PT023988 | 225100000X |
MA | 22695 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MA | 110120615A | Medicaid | |
MA | 4172419 | Other | AETNA |
MA | 441819 | Other | TUFTS |