Healthcare Provider Details

I. General information

NPI: 1285204727
Provider Name (Legal Business Name): ALEXANDRA SCHROEDER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA JOHNSON DPT

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11363 N PORT WASHINGTON RD
MEQUON WI
53092
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 262-833-2060
  • Fax: 262-833-2061
Mailing address:
  • Phone: 586-350-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15429-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: