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General NPI Number Information
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NPI Number | 1477054401
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Entity Type | Individual
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Provider Name | ALEXANDRA MARIE PATTERSON TICHY PT, DPT, SCS
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Gender | Female
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Dates
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Enumeration Date | 02/25/2018
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Last Update Date | 08/23/2020
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Provider Practice Location Address
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Address Line | 2160 COOLIDGE HWY
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City | BERKLEY
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State | MI
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Zip | 48072-1547
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 36 DEVONSHIRE RD
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City | PLEASANT RIDGE
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State | MI
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Zip | 48069-1211
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Country | US
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Telephone | 313-550-1592
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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 | 5501016151
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License Number State | MI
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