MEDICARE: ALEXIS SQUIRES PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	NM5091	NM
2	225100000X	Physical Therapist	1400688	TX

General Provider Information

NPI Number	:	1740702729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS SQUIRES PT

Provider Business Mailing Address
First Line	:	5667 FM 1488 RD
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-4299
Country	:	US
Telephone Number	:	281-766-0278
Fax Number	:

Provider Business Practice Location Address
First Line	:	5667 FM 1488 RD
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-4299
Country	:	US
Telephone Number	:	281-766-0278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	10/28/2024

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Directions to “ ALEXIS SQUIRES PT” Practice Location

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