Provider Demographics
NPI:1912351529
Name:VLADYKA, ALEXANDRA ELIZABETH (DAT, LAT, CSCS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:VLADYKA
Suffix:
Gender:F
Credentials:DAT, LAT, CSCS
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, CSCS
Mailing Address - Street 1:6839 E VIA ARROYO LARGO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-8392
Mailing Address - Country:US
Mailing Address - Phone:425-508-4948
Mailing Address - Fax:
Practice Address - Street 1:3100 S. CRAYCROFT ROAD
Practice Address - Street 2:79TH SQUADRON
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707
Practice Address - Country:US
Practice Address - Phone:425-508-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0089032255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer