Provider Demographics
NPI:1497264303
Name:DEHAESELEER, ALEXA ERIN
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:ERIN
Last Name:DEHAESELEER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17555 NORDHOFF ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2902
Mailing Address - Country:US
Mailing Address - Phone:818-447-2663
Mailing Address - Fax:
Practice Address - Street 1:1701 27TH ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7831
Practice Address - Country:US
Practice Address - Phone:818-447-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer