Healthcare Provider Details

I. General information

NPI: 1649625450
Provider Name (Legal Business Name): ALEXA ROYSTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 SPECTRUM BLVD STE B
RICHARDSON TX
75082-9703
US

IV. Provider business mailing address

3509 SPECTRUM BLVD STE B
RICHARDSON TX
75082-9703
US

V. Phone/Fax

Practice location:
  • Phone: 972-772-9600
  • Fax: 972-772-9601
Mailing address:
  • Phone: 972-772-9600
  • Fax: 972-772-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberS4379
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: