Provider Demographics
NPI:1508066515
Name:SULLIVAN, ALEXANDRA M (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:1051J VILLAGE HWY
Mailing Address - Street 2:
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-3800
Mailing Address - Country:US
Mailing Address - Phone:703-707-0706
Mailing Address - Fax:703-707-9288
Practice Address - Street 1:1051 VILLAGE HWY
Practice Address - Street 2:UNIT J
Practice Address - City:RUSTBURG
Practice Address - State:VA
Practice Address - Zip Code:24588-3800
Practice Address - Country:US
Practice Address - Phone:434-332-4240
Practice Address - Fax:434-332-4260
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist