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General NPI Number Information
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NPI Number | 1083566459
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Entity Type | Individual
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Provider Name | ALEXANDRA TAKAGISHI
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Gender | Female
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 614 N PINE ST
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City | DERIDDER
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State | LA
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Zip | 70634-3546
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Country | US
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Telephone | 337-202-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 16516 HOWARD ST APT A
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City | FORT POLK
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State | LA
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Zip | 71459-7907
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Country | US
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Telephone | 813-892-4967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12265
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License Number State | LA
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