ALEXIS ROSE MUTTILLO (NPI# 1942729355) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942729355 |
| Entity Type | Individual |
| Full Name | ALEXIS ROSE MUTTILLO |
| Practice Address |
1054 Cameron Creek Pkwy Tega Cay SC 29708 |
| Mailing Address |
1054 Cameron Creek Pkwy Tega Cay SC 29708-0078 |
| Practice Telephone | (803) 579-9474 |
| Mailing Telephone | 8035799474 |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2017-09-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
1054 CAMERON CREEK PKWY |
| City | TEGA CAY |
| State | SC |
| Zip Code | 29708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265089098 | Jennifer Priory O'keefe | Nurse Practitioner | 117 Stone Village Dr., Fort Mill, SC 29708 | 2019-08-26 |
| 1144790577 | Mary Kathleen Gerber | Speech-Language Pathologist | 1874 Second Baxter Crossing, Fort Mill, SC 29708 | 2018-11-28 |
| 1275016263 | R.e. Offutt, Dds, Ms and B.l. Cockerham Dds, Msp, Pllc | Dentist | 929 Market St, Fort Mill, SC 29708 | 2018-09-14 |
| 1861985384 | Hf Care Services LLC | Counselor | 150 B.w. Thomas Dr., 108, Fort Mills, SC 29708 | 2018-06-09 |
| 1134619802 | Myeyedr Optometry of South Carolina, LLC | Optometrist | 1826 Highway 160 W Ste 101, Fort Mill, SC 29708 | 2018-05-17 |
| 1255832549 | Lakeshore Dental Inc. | Dentist | 1200 Gold Hill Road, Fort Mill, SC 29708 | 2018-02-22 |
| 1407362338 | Smith Physical Therapy and Wellness | Physical Therapist | 2435 Highway 160 West, Suite 108, Tega Cay, SC 29708 | 2017-12-14 |
| 1841704244 | Modern Concepts, LLC | General Practice | 1808 Second Baxter Xing Ste 108, Fort Mill, SC 29708 | 2017-11-21 |
| 1407308208 | Brenda Terry | Acupuncturist | 1171 Market Street, Ste # 112, Fort Mill, SC 29708 | 2016-10-27 |
| 1558725366 | Tammy Lynn James | Social Worker | 1808 Second Baxter Xing Ste 208e, Fort Mill, SC 29708 | 2016-04-07 |
| Find all providers in zip 29708 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124586052 | Kaitlyn Vollmer | Student in an Organized Health Care Education/Training Program | 749 Beachwood Cove Dr, Tega Cay, SC 29708-8222 | 2019-03-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275141327 | Anne M. Stollberg | Student in an Organized Health Care Education/Training Program | 3 Pheasant Ct, Greenville, SC 29607-5441 | 2020-07-15 |
| 1891313292 | Zachary Blake Riggs | Student in an Organized Health Care Education/Training Program | 2025 Gervais St Unit 321c, Columbia, SC 29204-1803 | 2020-07-12 |
| 1144848797 | Katrina Marie Linenko | Student in an Organized Health Care Education/Training Program | 1051 Southern Dr Unit 3707c, Columbia, SC 29201-5622 | 2020-07-10 |
| 1275151870 | Soo Ji Mun | Student in an Organized Health Care Education/Training Program | 3049 Gedney Circle, Blythewood, SC 29016 | 2020-07-09 |
| 1790303402 | Kaitlyn Michele Pierce | Student in an Organized Health Care Education/Training Program | 1051 Southern Dr Unit 1905c, Columbia, SC 29201-5607 | 2020-07-09 |
| 1932727625 | Kati Mathis | Student in an Organized Health Care Education/Training Program | 907 Canterbury Rd, Anderson, SC 29621-1401 | 2020-07-08 |
| 1316565211 | Erin Maureen Bryant | Student in an Organized Health Care Education/Training Program | 811 Polo Rd Apt 517, Columbia, SC 29223-4426 | 2020-07-08 |
| 1790303634 | Benjamin Dillion | Student in an Organized Health Care Education/Training Program | 800 Alexander Rd Apt 354, Cayce, SC 29033-4383 | 2020-07-08 |
| 1265050132 | Leona Joyce Keller | Student in an Organized Health Care Education/Training Program | 1051 Southern Dr Unit 901, Columbia, SC 29201-5194 | 2020-07-08 |
| 1922626720 | Brett William Elder | Student in an Organized Health Care Education/Training Program | 1051 Southern Dr Unit 3707, Columbia, SC 29201-5622 | 2020-07-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.