Provider Demographics
NPI:1477319655
Name:WEFFER, ALICIA (PTA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WEFFER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BARROW DOWNS WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5304
Mailing Address - Country:US
Mailing Address - Phone:281-795-6611
Mailing Address - Fax:
Practice Address - Street 1:780 W BAY AREA BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4066
Practice Address - Country:US
Practice Address - Phone:281-316-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2059760225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant