Healthcare Provider Details

I. General information

NPI: 1467023671
Provider Name (Legal Business Name): ALEXANDRA DEE BRILLHART DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA DEE CAMMAN

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 MDG, 280 DAVID L. GOLDFEIN STREET BLDG 23
HOLLOMAN AFB NM
88330
US

IV. Provider business mailing address

49 MDG, 280 DAVID L. GOLDFEIN STREET BLDG 23
HOLLOMAN AFB NM
88330
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2021-0207
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11536
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: