Provider Demographics
NPI:1134932510
Name:LANDRY, ALEXIS (DPT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LANDRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 OLIVER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-4245
Mailing Address - Country:US
Mailing Address - Phone:857-472-0266
Mailing Address - Fax:
Practice Address - Street 1:356 THIRD ST FL 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1111
Practice Address - Country:US
Practice Address - Phone:617-536-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27072225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist