Provider Demographics
NPI:1952966921
Name:MAURATH, ALEXANDRA NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:MAURATH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:NICOLE
Other - Last Name:BURDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:7511 W 136TH PL APT 301
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-7306
Mailing Address - Country:US
Mailing Address - Phone:316-990-1370
Mailing Address - Fax:
Practice Address - Street 1:3908 MARYVILLE RD STE 2
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4197
Practice Address - Country:US
Practice Address - Phone:618-709-4125
Practice Address - Fax:618-709-4126
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05577225100000X
MO2017025190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist