Provider Demographics
NPI:1245858596
Name:LINDSTROM, ALEXIS (DOCTOR OF PT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:DOCTOR OF PT
Other - Prefix:DR
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:LINDSTROM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5300 MEMORIAL DR FL 2NF
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:WI
Mailing Address - Zip Code:54241-3923
Mailing Address - Country:US
Mailing Address - Phone:920-793-7570
Mailing Address - Fax:
Practice Address - Street 1:5300 MEMORIAL DR FL 2
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-3923
Practice Address - Country:US
Practice Address - Phone:920-793-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist