MEDICARE: ALEXANDRA CANDELA WHITTLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	3914	SC

General Provider Information

NPI Number	:	1992398275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA CANDELA WHITTLE

Provider Business Mailing Address
First Line	:	3005 HASWELL ST APT 1316
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-6412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 HASWELL ST APT 1316
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-6412
Country	:	US
Telephone Number	:	854-202-3436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	02/17/2021

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