Healthcare Provider Details

I. General information

NPI: 1992616650
Provider Name (Legal Business Name): ALEXI DAVIS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3026 CLUB DR
GASTONIA NC
28054-3941
US

IV. Provider business mailing address

3026 CLUB DR
GASTONIA NC
28054-3941
US

V. Phone/Fax

Practice location:
  • Phone: 704-299-3712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23558
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: