Provider Demographics
NPI:1689198392
Name:GRAZIANI, ALEXANDRA NICOLE (DPT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:GRAZIANI
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:MS
Other - First Name:ALEXANDRA
Other - Middle Name:NICOLE
Other - Last Name:KISSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:244 SWIHART ROAD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:814-525-4751
Mailing Address - Fax:
Practice Address - Street 1:382 WEST CHESTNUT STREET, SUITE 108B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-228-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
PAPT031032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program