Provider Demographics
NPI:1861082737
Name:VLADE, ALEXANDRA NIKOLAEVNA (PT)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:NIKOLAEVNA
Last Name:VLADE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5113 MACON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2231
Mailing Address - Country:US
Mailing Address - Phone:804-245-3323
Mailing Address - Fax:
Practice Address - Street 1:6410 ROCKLEDGE DR STE 301
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1841
Practice Address - Country:US
Practice Address - Phone:301-494-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist