Provider Demographics
NPI:1841879301
Name:TINER, ALEXIS ALL (LMT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ALL
Last Name:TINER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MCGOLDRICK WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2334
Mailing Address - Country:US
Mailing Address - Phone:970-426-6976
Mailing Address - Fax:
Practice Address - Street 1:1625 E PRATER WAY STE 103
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8963
Practice Address - Country:US
Practice Address - Phone:775-359-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10633225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist