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NPI Code Detail

MEDICARE: ALEXUS CHILDS ATC

MEDICARE: ALEXUS CHILDS ATC
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
1390200000XStudent in an Organized Health Care Education/Training Program
22255A2300XAthletic Trainer3024TN

General Provider Information

NPI Number : 1942877030
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXUS CHILDS ATC
Provider Business Mailing Address
First Line : 1645 DEXTER LAKE DR APT 303
Second Line :
City : CORDOVA
State : TN
Zip : 38016-1333
Country : US
Telephone Number : 910-580-1611
Fax Number :
Provider Business Practice Location Address
First Line : 1115 E GETWELL LOOP
Second Line :
City : MEMPHIS
State : TN
Zip : 38152-4210
Country : US
Telephone Number : 910-580-1611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2021
Last Update Date : 10/26/2022

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Directions to “ ALEXUS CHILDS ATC” Practice Location

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