Provider Demographics
NPI:1649745431
Name:EWY, ALEXANDRIA ASHLEY (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:ASHLEY
Last Name:EWY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALEXANDRIA
Other - Middle Name:A
Other - Last Name:WILLIAMS-SEYMOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 EAGAN WOODS DR
Mailing Address - Street 2:STE 200
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1138
Mailing Address - Country:US
Mailing Address - Phone:651-271-1592
Mailing Address - Fax:
Practice Address - Street 1:2620 EAGAN WOODS DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1138
Practice Address - Country:US
Practice Address - Phone:651-271-1592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist