Provider Demographics
NPI:1740956457
Name:ADAMS, ALEXANDRA RAE (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RAE
Last Name:ADAMS
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 1:575 NE 5TH TER APT 654
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-0004
Mailing Address - Country:US
Mailing Address - Phone:404-372-7040
Mailing Address - Fax:
Practice Address - Street 1:575 NE 5TH TER APT 654
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-0004
Practice Address - Country:US
Practice Address - Phone:786-770-9480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist