Healthcare Provider Details

I. General information

NPI: 1659637031
Provider Name (Legal Business Name): ALEXANDRA CISTO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA MARIGNONI

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 BEACON ST STE 2
BOSTON MA
02215-2099
US

IV. Provider business mailing address

654 BEACON ST STE 2
BOSTON MA
02215-2099
US

V. Phone/Fax

Practice location:
  • Phone: 617-536-1161
  • Fax: 617-536-1165
Mailing address:
  • Phone: 617-536-1161
  • Fax: 617-536-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19947
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: