Provider Demographics
NPI:1528675154
Name:COVERDALE, ALEXANDRA CHRISTINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CHRISTINE
Last Name:COVERDALE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1478
Mailing Address - Country:US
Mailing Address - Phone:704-824-7800
Mailing Address - Fax:704-824-2822
Practice Address - Street 1:8440 PITSTOP CT. NW
Practice Address - Street 2:SUITE 140
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8245
Practice Address - Country:US
Practice Address - Phone:704-960-1729
Practice Address - Fax:980-225-7274
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT299032225100000X
NCP21337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist