1578158960 NPI number — ALEXIS PHINISEY PT, DPT, ATC

Table of content: ALEXIS PHINISEY PT, DPT, ATC (NPI 1578158960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578158960 NPI number — ALEXIS PHINISEY PT, DPT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHINISEY
Provider First Name:
ALEXIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRAHLER
Provider Other First Name:
ALEXIS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578158960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1463 PEMBRIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45255-6104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-827-0887
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71451 TAMZEN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT CLAIRSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43950-8642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-751-5880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT017904 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)