Healthcare Provider Details

I. General information

NPI: 1861007718
Provider Name (Legal Business Name): ALEXIS LILLIAN BRANHAM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 08/11/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PROGRESS POINT PKWY STE 100
O FALLON MO
63368-2216
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1940
  • Fax: 314-747-7044
Mailing address:
  • Phone: 314-286-1940
  • Fax: 314-747-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026023735
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: