Provider Demographics
NPI:1942643622
Name:PROMIS, ALEXANDRA NOEL (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:NOEL
Last Name:PROMIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 POST RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1169
Mailing Address - Country:US
Mailing Address - Phone:203-307-4600
Mailing Address - Fax:
Practice Address - Street 1:53 OLD KINGS HWY N
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4735
Practice Address - Country:US
Practice Address - Phone:203-307-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist