Provider Demographics
NPI:1386269454
Name:ENCARNACION, ALEXIS ILEANA (ATC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ILEANA
Last Name:ENCARNACION
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 1:1333 E MORTEN AVE UNIT 208
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4560
Mailing Address - Country:US
Mailing Address - Phone:623-986-1848
Mailing Address - Fax:
Practice Address - Street 1:375 E VIRGINIA AVE STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1202
Practice Address - Country:US
Practice Address - Phone:602-264-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer