Provider Demographics
NPI:1376325027
Name:YOUNG, ALEXIS (PT, DPT, CLT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 GLACIER POINT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2541
Mailing Address - Country:US
Mailing Address - Phone:702-720-0611
Mailing Address - Fax:
Practice Address - Street 1:8545 GLACIER POINT ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2541
Practice Address - Country:US
Practice Address - Phone:702-720-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty