Provider Demographics
NPI:1710707690
Name:BROSSART, ALEXIS (LMT, RMA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BROSSART
Suffix:
Gender:F
Credentials:LMT, RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 CORDIAL PL
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-3161
Mailing Address - Country:US
Mailing Address - Phone:513-387-9312
Mailing Address - Fax:
Practice Address - Street 1:8966 GLENDALE MILFORD RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8908
Practice Address - Country:US
Practice Address - Phone:513-387-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist