Provider Demographics
NPI:1629670526
Name:VANFLEET, ALEXIS KATRIEN (ATC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KATRIEN
Last Name:VANFLEET
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10631 TOUCAN ST
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-0872
Mailing Address - Country:US
Mailing Address - Phone:937-620-9536
Mailing Address - Fax:
Practice Address - Street 1:10631 TOUCAN ST
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-0872
Practice Address - Country:US
Practice Address - Phone:937-620-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer