Provider Demographics
NPI:1710918479
Name:ELIAS-SPOHN, ALEXIS DELPHI (MPT T DPT)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:DELPHI
Last Name:ELIAS-SPOHN
Suffix:
Gender:F
Credentials:MPT T DPT
Other - Prefix:MISS
Other - First Name:ALEXIS
Other - Middle Name:DELPHI
Other - Last Name:ELIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9480 ROSEMONT DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241
Mailing Address - Country:US
Mailing Address - Phone:330-626-9865
Mailing Address - Fax:330-626-9845
Practice Address - Street 1:9480 ROSEMONT DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241
Practice Address - Country:US
Practice Address - Phone:330-626-9865
Practice Address - Fax:330-626-9845
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2552616374U00000X
OH11979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2552616Medicaid