Healthcare Provider Details

I. General information

NPI: 1487201190
Provider Name (Legal Business Name): ALEXIS ALYSE MCCAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7113 S WHITEVILLE RD
SHEPHERD MI
48883-8513
US

IV. Provider business mailing address

7113 S WHITEVILLE RD
SHEPHERD MI
48883-8513
US

V. Phone/Fax

Practice location:
  • Phone: 989-560-6290
  • Fax:
Mailing address:
  • Phone: 989-560-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005860
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: