Provider Demographics
NPI:1215582580
Name:KRESL, ALEXIS (DPT, PT)
Entity Type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:
Last Name:KRESL
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10071 FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3779
Mailing Address - Country:US
Mailing Address - Phone:480-707-2224
Mailing Address - Fax:
Practice Address - Street 1:9675 BRIGHTON WAY STE 250
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5180
Practice Address - Country:US
Practice Address - Phone:310-278-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist