Provider Demographics
NPI:1598063950
Name:MONROE, ALEXIS A (LMT)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:A
Last Name:MONROE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 EGLIN PKWY NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-2831
Mailing Address - Country:US
Mailing Address - Phone:850-269-2307
Mailing Address - Fax:850-226-6855
Practice Address - Street 1:625 EGLIN PKWY NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-2831
Practice Address - Country:US
Practice Address - Phone:850-269-2307
Practice Address - Fax:850-226-6855
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA35280173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA35280OtherLMT