Provider Demographics
NPI:1194494104
Name:HERMANOWSKI, ALEXANDRA TAYLOR (DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:TAYLOR
Last Name:HERMANOWSKI
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 1:42 HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2648
Mailing Address - Country:US
Mailing Address - Phone:631-925-8829
Mailing Address - Fax:
Practice Address - Street 1:259 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4119
Practice Address - Country:US
Practice Address - Phone:631-683-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist