Provider Demographics
NPI:1427442193
Name:CLEVELAND, ALEXIS RENAI (LAT, ATC)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:RENAI
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 QUAIL RUN DR APT 523
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1466
Mailing Address - Country:US
Mailing Address - Phone:219-240-6293
Mailing Address - Fax:
Practice Address - Street 1:2900 KICKBUSH DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-7104
Practice Address - Country:US
Practice Address - Phone:219-793-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer