Provider Demographics
NPI:1285149971
Name:WILKES, ALEXANDRA LANGE (PT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LANGE
Last Name:WILKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 N END AVE APT 24B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1234
Mailing Address - Country:US
Mailing Address - Phone:518-225-3993
Mailing Address - Fax:
Practice Address - Street 1:110 E 42ND ST RM 1504
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-8541
Practice Address - Country:US
Practice Address - Phone:212-354-2622
Practice Address - Fax:212-354-2752
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038868-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist