Provider Demographics
NPI:1447731740
Name:AUSTIN, ALEXIS BRIELLE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:BRIELLE
Last Name:AUSTIN
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 1:5035 OXFORD ST APT 21
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-1646
Mailing Address - Country:US
Mailing Address - Phone:757-952-4643
Mailing Address - Fax:
Practice Address - Street 1:5035 OXFORD ST APT 21
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-1646
Practice Address - Country:US
Practice Address - Phone:757-952-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer