Provider Demographics
NPI:1184149965
Name:CAELWAERTS, ALEXANDRIA M (D-PT)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:M
Last Name:CAELWAERTS
Suffix:
Gender:F
Credentials:D-PT
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:M
Other - Last Name:LIEBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:D-PT
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:725 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3500
Practice Address - Country:US
Practice Address - Phone:920-433-7995
Practice Address - Fax:920-433-3458
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13856-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist