Provider Demographics
NPI:1598120396
Name:MACKAY, ALEXANDRA L (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:L
Last Name:MACKAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:1850 E PARK AVE STE 112
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6706
Practice Address - Country:US
Practice Address - Phone:814-865-3566
Practice Address - Fax:814-863-7803
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5097225100000X
PAPT025569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032527570002Medicaid
PA1032527570002Medicaid