Provider Demographics
NPI:1548948284
Name:ROSER, ALEXANDRA LAVONNE (DPT)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:LAVONNE
Last Name:ROSER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ALEXANDRA
Other - Middle Name:LAVONNE
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:13768 ROSWELL AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1402
Mailing Address - Country:US
Mailing Address - Phone:909-902-5049
Mailing Address - Fax:
Practice Address - Street 1:13768 ROSWELL AVE STE 117
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1402
Practice Address - Country:US
Practice Address - Phone:909-902-5049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3042752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic