Provider Demographics
NPI:1952033581
Name:SUAREZ, ALEXANDRA MICHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MICHELLE
Last Name:SUAREZ
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 1:101 VICTORY CIR
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-6960
Mailing Address - Country:US
Mailing Address - Phone:956-536-5367
Mailing Address - Fax:
Practice Address - Street 1:101 VICTORY CIR
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-6960
Practice Address - Country:US
Practice Address - Phone:956-536-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2169113225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant