Provider Demographics
NPI:1952807604
Name:MERRITT, ALEXANDRA CHRISTINE (PTA, RMP)
Entity Type:Individual
Prefix:MISS
First Name:ALEXANDRA
Middle Name:CHRISTINE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:PTA, RMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N MAIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1027
Mailing Address - Country:US
Mailing Address - Phone:814-853-3625
Mailing Address - Fax:
Practice Address - Street 1:27 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1236
Practice Address - Country:US
Practice Address - Phone:301-432-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4783225200000X
MDR03621225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR03621OtherMARYLAND STATE BOARD OF MASSAGE THERAPY EXAMINERS