Healthcare Provider Details

I. General information

NPI: 1144655549
Provider Name (Legal Business Name): ALEXIS GRIFFIN PT, DPT, SCS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXIS ROSEMAN

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ACADEMY DR
AUSTIN TX
78704-1870
US

IV. Provider business mailing address

200 ACADEMY DR
AUSTIN TX
78704-1870
US

V. Phone/Fax

Practice location:
  • Phone: 563-554-7413
  • Fax:
Mailing address:
  • Phone: 563-554-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number014373
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: