Healthcare Provider Details

I. General information

NPI: 1164857579
Provider Name (Legal Business Name): ALEXANDRA CHOURAMANIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 TREMONT ST
BOSTON MA
02120-3447
US

IV. Provider business mailing address

535 S MAIN ST
RANDOLPH MA
02368-5261
US

V. Phone/Fax

Practice location:
  • Phone: 617-267-3773
  • Fax: 617-602-1010
Mailing address:
  • Phone: 781-961-3370
  • Fax: 781-767-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20495
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: