Healthcare Provider Details

I. General information

NPI: 1003524331
Provider Name (Legal Business Name): ALEXIS GLASBY BS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MERIDIAN ST NW
NORMAL AL
35762-7500
US

IV. Provider business mailing address

1731 PARKER RD
SAINT LOUIS MO
63138-1910
US

V. Phone/Fax

Practice location:
  • Phone: 256-372-8457
  • Fax:
Mailing address:
  • Phone: 314-278-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2548
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: