Healthcare Provider Details

I. General information

NPI: 1477147551
Provider Name (Legal Business Name): ALEXANDRA HEINRICH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 HIGHWAY 96 E STE 120
VADNAIS HEIGHTS MN
55127-2557
US

IV. Provider business mailing address

575 CLEVELAND AVE S APT 8
SAINT PAUL MN
55116-1261
US

V. Phone/Fax

Practice location:
  • Phone: 651-482-8486
  • Fax:
Mailing address:
  • Phone: 651-500-9569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11983
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: