Provider Demographics
NPI:1043728645
Name:DSOUZA, ALEXANDRIA (PT)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:DSOUZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 BROADWAY RM 202
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9835
Mailing Address - Country:US
Mailing Address - Phone:212-354-2225
Mailing Address - Fax:
Practice Address - Street 1:1410 BROADWAY
Practice Address - Street 2:SUITE # 202
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1001
Practice Address - Country:US
Practice Address - Phone:212-354-2225
Practice Address - Fax:212-354-2225
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042658-01208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty