Provider Demographics
NPI:1922610500
Name:ELROD, ALEXIS LAUREN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:LAUREN
Last Name:ELROD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:MRS
Other - First Name:ALEXIS
Other - Middle Name:ELROD
Other - Last Name:WALDROP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:122 LOCHE DR
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-9411
Mailing Address - Country:US
Mailing Address - Phone:864-752-7845
Mailing Address - Fax:
Practice Address - Street 1:907 WESLEYAN DR
Practice Address - Street 2:
Practice Address - City:CENTRAL
Practice Address - State:SC
Practice Address - Zip Code:29630-9748
Practice Address - Country:US
Practice Address - Phone:864-644-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2000032522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer