Provider Demographics
NPI:1629877394
Name:PETERSON, ALEXANDRIA NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:NICOLE
Last Name:PETERSON
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 1:1244 PRIMACY PKWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0201
Mailing Address - Country:US
Mailing Address - Phone:901-767-8690
Mailing Address - Fax:901-763-1942
Practice Address - Street 1:1244 PRIMACY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0201
Practice Address - Country:US
Practice Address - Phone:901-767-8690
Practice Address - Fax:901-763-1942
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist