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NPI Code Detail

MEDICARE: ALEXIS WAETZIG PT, DPT

MEDICARE: ALEXIS WAETZIG PT, DPT
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
1225100000XPhysical Therapist1349652TX

General Provider Information

NPI Number : 1619631884
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXIS WAETZIG PT, DPT
Provider Business Mailing Address
First Line : 13905 CHARLES ABRAHAM WAY
Second Line :
City : MANOR
State : TX
Zip : 78653-2047
Country : US
Telephone Number : 760-413-0847
Fax Number :
Provider Business Practice Location Address
First Line : 8300 N MOPAC EXPY STE 150
Second Line :
City : AUSTIN
State : TX
Zip : 78759-0027
Country : US
Telephone Number : 512-872-2180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2021
Last Update Date : 10/25/2021

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