Provider Demographics
NPI:1508632100
Name:WOLFE, ALEXIS L (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:L
Other - Last Name:BOTKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1317 E REPUBLIC RD STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7204
Mailing Address - Country:US
Mailing Address - Phone:417-766-3086
Mailing Address - Fax:
Practice Address - Street 1:1317 E REPUBLIC RD STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7204
Practice Address - Country:US
Practice Address - Phone:417-766-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200289502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic