Provider Demographics
NPI:1275399412
Name:ALEXIS, KHALEF RAHHIMM
Entity Type:Individual
Prefix:
First Name:KHALEF
Middle Name:RAHHIMM
Last Name:ALEXIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 SUMMERS DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-4919
Mailing Address - Country:US
Mailing Address - Phone:817-862-8839
Mailing Address - Fax:
Practice Address - Street 1:111 W DAVIS ST APT 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4554
Practice Address - Country:US
Practice Address - Phone:817-862-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT138701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist