Basic Information
| Provider Information | |||||||||
| NPI: | 1053902890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMES | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | DIVINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905A LINNEY LN | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281526411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9805858125 | ||||||||
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| Practice Location | |||||||||
| Address1: | 910 E MAIN ST | ||||||||
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| City: | LINCOLNTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280923449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047480616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2021 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.