Provider Demographics
NPI:1669775359
Name:VIGLIAROLO, ALEXANDRA MEGAN (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MEGAN
Last Name:VIGLIAROLO
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 1:6945 PINE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9555
Mailing Address - Country:US
Mailing Address - Phone:616-485-2883
Mailing Address - Fax:
Practice Address - Street 1:542 16TH ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5241
Practice Address - Country:US
Practice Address - Phone:307-324-2759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1589225100000X
MTPTP-PT-LIC-15198225100000X
WAPT60396893225100000X
OR6422225100000X
MI5501017894225100000X
AKPHYP2797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist