Provider Demographics
NPI:1083903223
Name:AGER, ALEX (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:AGER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11318 CRESTBROOK PARK LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-2250
Mailing Address - Country:US
Mailing Address - Phone:254-733-3949
Mailing Address - Fax:
Practice Address - Street 1:19428 NORTH FWY # I45
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2910
Practice Address - Country:US
Practice Address - Phone:254-733-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT49242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer