MEDICARE: ALEXIS FANNIN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	PT017516	OH

General Provider Information

NPI Number	:	1063371508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS FANNIN PT, DPT

Provider Business Mailing Address
First Line	:	3430 BURNET AVENUE
Second Line	:	4007
City	:	CINCINNATI
State	:	OH
Zip	:	45229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 BURNET AVENUE
Second Line	:	4007
City	:	CINCINNATI
State	:	OH
Zip	:	45229
Country	:	US
Telephone Number	:	513-636-4601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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