MEDICARE: ALEXIS CLAUDE

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	225100000X	Physical Therapist	20987	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K077-0002	OTHER	MD	BCBS

General Provider Information

NPI Number	:	1538241856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS CLAUDE

Provider Business Mailing Address
First Line	:	2201 WOODVALE LN
Second Line	:
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-4132
Country	:	US
Telephone Number	:	410-499-7988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 GWYNN OAK AVE
Second Line	:
City	:	WOODLAWN
State	:	MD
Zip	:	21207-5280
Country	:	US
Telephone Number	:	240-372-0614
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/30/2016

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Directions to “ ALEXIS CLAUDE ” Practice Location

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