Healthcare Provider Details

I. General information

NPI: 1891026274
Provider Name (Legal Business Name): MR. ALEXIS BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2437 W ALLEGHENY AVE
PHILADELPHIA PA
19132-1322
US

IV. Provider business mailing address

2437 W ALLEGHENY AVE
PHILADELPHIA PA
19132-1322
US

V. Phone/Fax

Practice location:
  • Phone: 215-908-7003
  • Fax:
Mailing address:
  • Phone: 215-908-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: