Provider Demographics
NPI:1760510952
Name:EMMERSON, ALEXI MERCEDES (ATC)
Entity Type:Individual
Prefix:
First Name:ALEXI
Middle Name:MERCEDES
Last Name:EMMERSON
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 1:940 SE CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1684
Mailing Address - Country:US
Mailing Address - Phone:509-527-5590
Mailing Address - Fax:
Practice Address - Street 1:345 BOYER AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2067
Practice Address - Country:US
Practice Address - Phone:509-527-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer