Provider Demographics
NPI:1104274877
Name:FLEMING, ALEXIS LA'RAINE (ATC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:LA'RAINE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305167
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00803-5167
Mailing Address - Country:US
Mailing Address - Phone:340-473-6521
Mailing Address - Fax:
Practice Address - Street 1:1001 ESTATE ROSS
Practice Address - Street 2:SUITE 6 BARBEL PLAZA
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-779-4678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI20000235202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer