Provider Demographics
NPI:1568130003
Name:NEWARK, ALEXANDRA (PT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:NEWARK
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 1:1650 LEE LN
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-3935
Mailing Address - Country:US
Mailing Address - Phone:608-365-8660
Mailing Address - Fax:608-364-4670
Practice Address - Street 1:1650 LEE LN
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3935
Practice Address - Country:US
Practice Address - Phone:608-365-8660
Practice Address - Fax:608-364-4670
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6952-26225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist