Provider Demographics
NPI:1609477736
Name:DAVIS, ALEXIS (PT,DPT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:WISEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 BLUE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-5794
Mailing Address - Country:US
Mailing Address - Phone:270-735-7563
Mailing Address - Fax:
Practice Address - Street 1:225 SAINT JOHN RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2918
Practice Address - Country:US
Practice Address - Phone:270-769-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist