Provider Demographics
NPI:1487639670
Name:SHEA, ALEXA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALEXA
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ALEXA
Other - Middle Name:
Other - Last Name:ARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:8348 TRAFORD LN STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1650
Practice Address - Country:US
Practice Address - Phone:703-569-7335
Practice Address - Fax:703-569-0665
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
VA2305212923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist