Basic Information
| Provider Information | |||||||||
| NPI: | 1003285537 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HUMPHRIES | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4617 W 20TH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806343207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703529022 | ||||||||
| FaxNumber: | 9703529048 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 W GREENWAY ST | ||||||||
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| City: | DERBY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670372641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167886734 | ||||||||
| FaxNumber: | 3167884529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2015 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11-06700 | KS | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251X0800X | PTL.0013636 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.