Provider Demographics
NPI:1194187856
Name:LIPE, ALEXA SHERIDAN (DPT)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:SHERIDAN
Last Name:LIPE
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 1:14103 UNDERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36580-4319
Mailing Address - Country:US
Mailing Address - Phone:817-793-0433
Mailing Address - Fax:
Practice Address - Street 1:18700 US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-3271
Practice Address - Country:US
Practice Address - Phone:251-947-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist