Provider Demographics
NPI:1639556707
Name:GARNETT, ALEXANDRA ELYSE (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELYSE
Last Name:GARNETT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:MATUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-463-5600
Mailing Address - Fax:
Practice Address - Street 1:2801 YOUNGFIELD ST STE 150
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-0209
Practice Address - Country:US
Practice Address - Phone:303-238-4277
Practice Address - Fax:303-238-4977
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0062738208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation