Provider Demographics
NPI:1588960462
Name:ALEXANDER, MARVIN D (PT)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:D
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:MARVIN
Other - Middle Name:D
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:17515 HEATH GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8031
Mailing Address - Country:US
Mailing Address - Phone:832-205-2097
Mailing Address - Fax:
Practice Address - Street 1:13009 BAILEYS RUN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1457
Practice Address - Country:US
Practice Address - Phone:832-205-2097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113264171W00000X
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No171W00000XOther Service ProvidersContractor