Provider Demographics
NPI:1366119455
Name:PETRARCA, ALEXANDRA NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:PETRARCA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LOWER RAGSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5827
Mailing Address - Country:US
Mailing Address - Phone:831-264-6040
Mailing Address - Fax:
Practice Address - Street 1:21 LOWER RAGSDALE DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5827
Practice Address - Country:US
Practice Address - Phone:831-264-6040
Practice Address - Fax:831-375-8007
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300575OtherPHYSICAL THERAPY LICENSE