Provider Demographics
NPI:1336823665
Name:STANLEY, ALEXIS MADYSIN
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MADYSIN
Last Name:STANLEY
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 1:183 WOODLAKE LN
Mailing Address - Street 2:
Mailing Address - City:AXTELL
Mailing Address - State:TX
Mailing Address - Zip Code:76624-1233
Mailing Address - Country:US
Mailing Address - Phone:254-205-0817
Mailing Address - Fax:
Practice Address - Street 1:183 WOODLAKE LN
Practice Address - Street 2:
Practice Address - City:AXTELL
Practice Address - State:TX
Practice Address - Zip Code:76624-1233
Practice Address - Country:US
Practice Address - Phone:254-205-0817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer