Provider Demographics
NPI:1962937839
Name:SMITH, ALEXIS NICOLE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5144 ROYAL BIRKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-5189
Mailing Address - Country:US
Mailing Address - Phone:240-472-9172
Mailing Address - Fax:
Practice Address - Street 1:5144 ROYAL BIRKDALE AVE
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-5189
Practice Address - Country:US
Practice Address - Phone:240-472-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer