Provider Demographics
NPI:1235985466
Name:HERNANDEZ, ALEXA GABRIELLE
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:GABRIELLE
Last Name:HERNANDEZ
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 1:1811 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-9421
Mailing Address - Country:US
Mailing Address - Phone:816-695-1335
Mailing Address - Fax:
Practice Address - Street 1:105 SW EAGLES PKWY
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8512
Practice Address - Country:US
Practice Address - Phone:816-265-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist