Provider Demographics
NPI:1669274601
Name:DANDRIDGE, ALEXIS NOELL
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:NOELL
Last Name:DANDRIDGE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 W GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61607-1746
Mailing Address - Country:US
Mailing Address - Phone:309-839-0470
Mailing Address - Fax:309-838-0664
Practice Address - Street 1:124 SW ADAMS ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1308
Practice Address - Country:US
Practice Address - Phone:309-839-0470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070028113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist