Provider Demographics
NPI:1023467982
Name:RODRIGUEZ, ALEXIS LACE (LMT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LACE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24932 AURORA RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1788
Mailing Address - Country:US
Mailing Address - Phone:440-439-9440
Mailing Address - Fax:440-439-1808
Practice Address - Street 1:24932 AURORA RD
Practice Address - Street 2:SUITE C
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1788
Practice Address - Country:US
Practice Address - Phone:440-439-9440
Practice Address - Fax:440-439-1808
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.022343225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist