Provider Demographics
NPI:1356141378
Name:MASARIK, ALEXANDRA RAE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:RAE
Last Name:MASARIK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 REITZ QUINN RD
Mailing Address - Street 2:
Mailing Address - City:CAT SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:78933-5386
Mailing Address - Country:US
Mailing Address - Phone:979-633-0428
Mailing Address - Fax:
Practice Address - Street 1:962 CORONADO BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3228
Practice Address - Country:US
Practice Address - Phone:210-526-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1406560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist