Provider Demographics
NPI:1700457751
Name:SCHAFFER, ALEXIS (DPT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N KIMBALL ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1164
Mailing Address - Country:US
Mailing Address - Phone:605-996-8712
Mailing Address - Fax:
Practice Address - Street 1:2100 N KIMBALL ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1164
Practice Address - Country:US
Practice Address - Phone:605-996-8712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2322208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation