Provider Demographics
NPI:1053062422
Name:POWELL-YEARBY, ALEXIS (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:POWELL-YEARBY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6421 BORASCO DR APT 1202
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6125
Mailing Address - Country:US
Mailing Address - Phone:321-588-3008
Mailing Address - Fax:
Practice Address - Street 1:1508 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4654
Practice Address - Country:US
Practice Address - Phone:321-588-3008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98026225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist