Healthcare Provider Details

I. General information

NPI: 1508068503
Provider Name (Legal Business Name): ALEXANDRA SASHA TSIBUR-MAYER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 2ND AVE W
DICKINSON ND
58601-3916
US

IV. Provider business mailing address

324 3RD ST N
RICHARDTON ND
58652-7110
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4378
  • Fax: 701-456-4809
Mailing address:
  • Phone: 701-690-9840
  • Fax: 701-456-4809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1224
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: