MEDICARE: ALEXI CHARTER D.P.T.

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	1509	NM

General Provider Information

NPI Number	:	1720461312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXI CHARTER D.P.T.

Provider Business Mailing Address
First Line	:	310 W 11TH ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5113
Country	:	US
Telephone Number	:	575-534-1187
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 W 11TH ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5113
Country	:	US
Telephone Number	:	575-534-1187
Fax Number	:

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

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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