Healthcare Provider Details

I. General information

NPI: 1538241856
Provider Name (Legal Business Name): ALEXIS CLAUDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 GWYNN OAK AVE
WOODLAWN MD
21207-5280
US

IV. Provider business mailing address

2201 WOODVALE LN
MITCHELLVILLE MD
20721-4132
US

V. Phone/Fax

Practice location:
  • Phone: 240-372-0614
  • Fax:
Mailing address:
  • Phone: 410-499-7988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20987
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: