Provider Demographics
NPI:1033857933
Name:MCBRIDE, ALVON JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:ALVON
Middle Name:JOSEPH
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 COUNTY ROAD 290
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-4824
Mailing Address - Country:US
Mailing Address - Phone:903-714-9516
Mailing Address - Fax:
Practice Address - Street 1:1308 FM 3062
Practice Address - Street 2:
Practice Address - City:MALAKOFF
Practice Address - State:TX
Practice Address - Zip Code:75148-6125
Practice Address - Country:US
Practice Address - Phone:903-489-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-22
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist