Provider Demographics
NPI:1003285537
Name:HUMPHRIES, ALEXANDRA
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 W 20TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3207
Mailing Address - Country:US
Mailing Address - Phone:970-352-9022
Mailing Address - Fax:970-352-9048
Practice Address - Street 1:234 W GREENWAY ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2641
Practice Address - Country:US
Practice Address - Phone:316-788-6734
Practice Address - Fax:316-788-4529
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06700225100000X
COPTL.00136362251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist