Provider Demographics
NPI:1437499225
Name:SWEET, ALEXIS JANELLA (PTA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JANELLA
Last Name:SWEET
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 E WARNER RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2336
Mailing Address - Country:US
Mailing Address - Phone:623-680-3142
Mailing Address - Fax:
Practice Address - Street 1:1855 E GUADALUPE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3273
Practice Address - Country:US
Practice Address - Phone:480-839-8552
Practice Address - Fax:480-752-7978
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10043A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant