Provider Demographics
NPI:1992251896
Name:CUSHMAN, ALEXANDRA JOANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JOANNE
Last Name:CUSHMAN
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 1:1045 N VULCAN AVE APT D
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1793
Mailing Address - Country:US
Mailing Address - Phone:804-938-0331
Mailing Address - Fax:
Practice Address - Street 1:1922 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081
Practice Address - Country:US
Practice Address - Phone:760-295-4175
Practice Address - Fax:760-295-4176
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA218327Medicare PIN
CACB264476Medicare PIN
CACA218328Medicare PIN