Healthcare Provider Details

I. General information

NPI: 1063371508
Provider Name (Legal Business Name): ALEXIS FANNIN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 BURNET AVENUE 4007
CINCINNATI OH
45229
US

IV. Provider business mailing address

3430 BURNET AVENUE 4007
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT017516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: