Provider Demographics
NPI:1740702729
Name:SQUIRES, ALEXIS (PT)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:SQUIRES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5667 FM 1488 RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4299
Mailing Address - Country:US
Mailing Address - Phone:281-766-0278
Mailing Address - Fax:
Practice Address - Street 1:5667 FM 1488 RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4299
Practice Address - Country:US
Practice Address - Phone:281-766-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM5091225100000X
TX1400688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist