Basic Information
| Provider Information | |||||||||
| NPI: | 1679052815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARCUS | ||||||||
| FirstName: | ALEXANDRIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 SAINT LOUIS AVE | ||||||||
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| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761043366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179215020 | ||||||||
| FaxNumber: | 8179215022 | ||||||||
| Practice Location | |||||||||
| Address1: | 1351 E BARDIN RD STE 160 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760182136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177951291 | ||||||||
| FaxNumber: | 8179215022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2018 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1308279 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.