Provider Demographics
NPI:1457857427
Name:ALEXIS, TANIA (MA, FS)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:ALEXIS
Suffix:
Gender:
Credentials:MA, FS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4861 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1409
Mailing Address - Country:US
Mailing Address - Phone:954-636-0169
Mailing Address - Fax:
Practice Address - Street 1:150 S UNIVERSITY DR STE B
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3327
Practice Address - Country:US
Practice Address - Phone:954-833-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA88446225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist