Healthcare Provider Details

I. General information

NPI: 1912541020
Provider Name (Legal Business Name): ALEXANDRA PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E 12 MILE RD STE B
MADISON HEIGHTS MI
48071-2522
US

IV. Provider business mailing address

520 E 12 MILE RD STE B
MADISON HEIGHTS MI
48071-2522
US

V. Phone/Fax

Practice location:
  • Phone: 586-522-9255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RIZAAN RAHEEM
Title or Position: OWNER
Credential:
Phone: 586-522-9255