Provider Demographics
NPI:1821597089
Name:ABRAHAM, ALEXIA
Entity Type:Individual
Prefix:MS
First Name:ALEXIA
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 ALYSIA CT APT 302
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7534
Mailing Address - Country:US
Mailing Address - Phone:803-566-3078
Mailing Address - Fax:803-566-3078
Practice Address - Street 1:470 ALYSIA CT APT 302
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-7534
Practice Address - Country:US
Practice Address - Phone:803-566-3078
Practice Address - Fax:803-566-3078
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer