Provider Demographics
NPI:1932724176
Name:MISCHKE, ALEXANDRA (BCSI)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MISCHKE
Suffix:
Gender:F
Credentials:BCSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WATER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-4812
Mailing Address - Country:US
Mailing Address - Phone:617-257-6857
Mailing Address - Fax:
Practice Address - Street 1:2464 MASSACHUSETTS AVE STE 315A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1648
Practice Address - Country:US
Practice Address - Phone:617-257-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist