Provider Demographics
NPI:1063821841
Name:KNOWLDEN, ALEXIS (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:KNOWLDEN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 SHUMWAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-6835
Mailing Address - Country:US
Mailing Address - Phone:570-220-5756
Mailing Address - Fax:
Practice Address - Street 1:225 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1144
Practice Address - Country:US
Practice Address - Phone:570-724-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0048362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer