Individual
ALEXA MAMMEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
11830 W MARKET PL, FULTON, MD 20759-2431
(667) 205-4290
Mailing address
11830 W MARKET PL STE N-Q, FULTON, MD 20759-2431
(248) 918-9508
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
28647
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/03/2019
Last updated
04/12/2022
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