Provider Demographics
NPI:1790236388
Name:PEVAR, ALEXANDRA ERIN (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:ERIN
Last Name:PEVAR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CLYTH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2610
Mailing Address - Country:US
Mailing Address - Phone:302-530-8004
Mailing Address - Fax:
Practice Address - Street 1:6 CLYTH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2610
Practice Address - Country:US
Practice Address - Phone:302-530-8004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025592225100000X
DEJ1-0003187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist