Provider Demographics
NPI:1518189653
Name:BUWALDA, ALEXANDRA (MS)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:
Last Name:BUWALDA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 8TH AVE
Mailing Address - Street 2:APT 1L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2234
Mailing Address - Country:US
Mailing Address - Phone:718-638-9544
Mailing Address - Fax:
Practice Address - Street 1:189 8TH AVE
Practice Address - Street 2:APT 1L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2234
Practice Address - Country:US
Practice Address - Phone:718-638-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023416-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist