Healthcare Provider Details

I. General information

NPI: 1740702729
Provider Name (Legal Business Name): ALEXIS SQUIRES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 FM 1488 RD
MAGNOLIA TX
77354-4299
US

IV. Provider business mailing address

5667 FM 1488 RD
MAGNOLIA TX
77354-4299
US

V. Phone/Fax

Practice location:
  • Phone: 281-766-0278
  • Fax:
Mailing address:
  • Phone: 281-766-0278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberNM5091
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1400688
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: