Provider Demographics
NPI:1740928530
Name:WAKEHAM, ALEXIS (PTA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:WAKEHAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:200 W DOUGLAS AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3002
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:
Practice Address - Street 1:3730 N RIDGE RD STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1233
Practice Address - Country:US
Practice Address - Phone:316-440-4901
Practice Address - Fax:316-440-4904
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant