Provider Demographics
NPI:1114187796
Name:CLARK, ALEXIS ANNE (PT,DPT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:ANNE
Other - Last Name:DOMHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-497-0005
Mailing Address - Fax:
Practice Address - Street 1:860 BEAVER GRADE RD STE C
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2639
Practice Address - Country:US
Practice Address - Phone:878-999-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 022571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist