Provider Demographics
NPI:1043970049
Name:PETZOLD, ALAINA CHRISTEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALAINA
Middle Name:CHRISTEN
Last Name:PETZOLD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ALAINA
Other - Middle Name:
Other - Last Name:DOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1840 E STATE HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-4625
Mailing Address - Country:US
Mailing Address - Phone:979-250-5135
Mailing Address - Fax:979-250-5134
Practice Address - Street 1:1840 E STATE HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-4625
Practice Address - Country:US
Practice Address - Phone:979-250-5135
Practice Address - Fax:979-250-5134
Is Sole Proprietor?:No
Enumeration Date:2021-12-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1335906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist