Individual
ALEXIS LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
107 S INDIANA AVE, BLOOMINGTON, IN 47405-7000
(812) 855-4848
Mailing address
2801 W HEARTWOOD CT APT H, BLOOMINGTON, IN 47403-5259
(317) 514-0240
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0279-6889
EMT
IN
Enumeration date
09/28/2016
Last updated
09/28/2016
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