Provider Demographics
NPI:1518673318
Name:LEXI'S BOUTIQUE LLC
Entity Type:Organization
Organization Name:LEXI'S BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:MONAE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CRC, CPMA, RHIT
Authorized Official - Phone:443-416-2675
Mailing Address - Street 1:3802 WOODLEA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5034
Mailing Address - Country:US
Mailing Address - Phone:443-416-2675
Mailing Address - Fax:
Practice Address - Street 1:3802 WOODLEA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-5034
Practice Address - Country:US
Practice Address - Phone:443-416-2675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier