Provider Demographics
NPI:1215767223
Name:JORGENSEN, ALYX (PT)
Entity type:Individual
Prefix:
First Name:ALYX
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALYX
Other - Middle Name:
Other - Last Name:FLIPPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20963 500TH ST
Mailing Address - Street 2:
Mailing Address - City:GRISWOLD
Mailing Address - State:IA
Mailing Address - Zip Code:51535-4027
Mailing Address - Country:US
Mailing Address - Phone:402-709-8986
Mailing Address - Fax:
Practice Address - Street 1:20963 500TH ST
Practice Address - Street 2:
Practice Address - City:GRISWOLD
Practice Address - State:IA
Practice Address - Zip Code:51535-4027
Practice Address - Country:US
Practice Address - Phone:402-709-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist