Provider Demographics
NPI:1003495821
Name:ANDERSON, ALEXANDER MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:MICHAEL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412307
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5258
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:4290 IVY RD STE 120
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-7010
Practice Address - Country:US
Practice Address - Phone:434-327-5244
Practice Address - Fax:434-326-1353
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTCP043701T225100000X
WVCP043698T225100000X
COCP043700T225100000X
SCCP043699T225100000X
PAPT033242225100000X
NY054137225100000X
NECP043805T225100000X
INCP043806T225100000X
WACP043807T225100000X
VA2305214608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist