Provider Demographics
NPI:1588220867
Name:MIESBAUER, ALEXA JESSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:JESSE
Last Name:MIESBAUER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:JESSE
Other - Last Name:EDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:709 VICTORIA ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3169
Mailing Address - Country:US
Mailing Address - Phone:605-280-8016
Mailing Address - Fax:
Practice Address - Street 1:2090 WOODWINDS DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2522
Practice Address - Country:US
Practice Address - Phone:651-968-5600
Practice Address - Fax:651-968-5898
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist