Basic Information
Provider Information
NPI: 1710354972
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LECUYER
FirstName: ALYSHA
MiddleName: LINNETTE
NamePrefix:  
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 305 NE LOOP 820
Address2: BUSINESS TOWER 1 SUITE 200
City: HURST
State: TX
PostalCode: 760537209
CountryCode: US
TelephoneNumber: 8172928787
FaxNumber: 8177896849
Practice Location
Address1: 915 W EXCHANGE PKWY
Address2: #100
City: ALLEN
State: TX
PostalCode: 750137017
CountryCode: US
TelephoneNumber: 2145471517
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/24/2015
LastUpdateDate: 08/24/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X4055200TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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