Provider Demographics
NPI:1508068503
Name:TSIBUR-MAYER, ALEXANDRA SASHA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:SASHA
Last Name:TSIBUR-MAYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:RICHARDTON
Mailing Address - State:ND
Mailing Address - Zip Code:58652-7110
Mailing Address - Country:US
Mailing Address - Phone:701-690-9840
Mailing Address - Fax:701-456-4809
Practice Address - Street 1:986 2ND AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3916
Practice Address - Country:US
Practice Address - Phone:701-456-4378
Practice Address - Fax:701-456-4809
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist