Provider Demographics
NPI:1578930921
Name:ANDERSON, ALEXANDRA (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N CLINTON ST STE 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1283
Mailing Address - Country:US
Mailing Address - Phone:877-709-1090
Mailing Address - Fax:866-221-3400
Practice Address - Street 1:211 N CLINTON ST STE 2N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1283
Practice Address - Country:US
Practice Address - Phone:877-709-1090
Practice Address - Fax:866-221-3400
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12615002251X0800X
IL0700227392251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic