Healthcare Provider Details

I. General information

NPI: 1508066515
Provider Name (Legal Business Name): ALEXANDRA M SULLIVAN PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 VILLAGE HWY UNIT J
RUSTBURG VA
24588-3800
US

IV. Provider business mailing address

1051J VILLAGE HWY
RUSTBURG VA
24588-3800
US

V. Phone/Fax

Practice location:
  • Phone: 434-332-4240
  • Fax: 434-332-4260
Mailing address:
  • Phone: 703-707-0706
  • Fax: 703-707-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: