Provider Demographics
NPI:1548668064
Name:ANDERSON, ALEXIS FAITH (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:FAITH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 S ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1832
Mailing Address - Country:US
Mailing Address - Phone:715-246-3809
Mailing Address - Fax:715-246-7139
Practice Address - Street 1:471 S ARCH AVE
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1832
Practice Address - Country:US
Practice Address - Phone:715-246-3809
Practice Address - Fax:715-246-7139
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI127362251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic