Provider Demographics
NPI:1700779469
Name:MATHEWS, ALEXA MARIE
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARIE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 LAKE PARK RD APT 507
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6607
Mailing Address - Country:US
Mailing Address - Phone:760-881-9859
Mailing Address - Fax:
Practice Address - Street 1:2375 LAKE PARK RD APT 507
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-6607
Practice Address - Country:US
Practice Address - Phone:760-881-9859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer