Provider Demographics
NPI:1558047183
Name:ALEXANDER, JOVON (PTA)
Entity Type:Individual
Prefix:
First Name:JOVON
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CHUCKWAGON CT
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-2748
Mailing Address - Country:US
Mailing Address - Phone:979-997-6926
Mailing Address - Fax:
Practice Address - Street 1:6845 PEEK RD STE 150
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-0083
Practice Address - Country:US
Practice Address - Phone:346-291-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2175156225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant