Provider Demographics
NPI:1528789054
Name:ALICIA'S BODY RESTORATION CLIMIC
Entity type:Organization
Organization Name:ALICIA'S BODY RESTORATION CLIMIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:SHERRAY
Authorized Official - Last Name:MYLES
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:832-757-6001
Mailing Address - Street 1:1660 KATY GAP RD APT 34105
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7733
Mailing Address - Country:US
Mailing Address - Phone:832-757-6001
Mailing Address - Fax:
Practice Address - Street 1:23410 GRAND RESERVE DR STE 604
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4968
Practice Address - Country:US
Practice Address - Phone:832-220-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty