Individual
ALEXA LEAF LASER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7082 BITTERNUT LN, PLAINFIELD, IN 46168-8697
(317) 997-1066
Mailing address
7082 BITTERNUT LN, PLAINFIELD, IN 46168-8697
(317) 997-1066
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/28/2017
Last updated
11/28/2017
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