Healthcare Provider Details

I. General information

NPI: 1316864325
Provider Name (Legal Business Name): ALEXANDRIA BAILEY TERRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SAGECREST CIR APT 304
WEST MELBOURNE FL
32904-8639
US

IV. Provider business mailing address

2903 W NEW HAVEN AVE # 481
WEST MELBOURNE FL
32904-3661
US

V. Phone/Fax

Practice location:
  • Phone: 515-689-5202
  • Fax:
Mailing address:
  • Phone: 515-689-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA106804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: