Provider Demographics
NPI:1598597262
Name:WILLIAMS, ALEXANDRIA ROSE
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:ROSE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 CLOVER HILL RD APT 3103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-6533
Mailing Address - Country:US
Mailing Address - Phone:504-920-6190
Mailing Address - Fax:
Practice Address - Street 1:1511 CLOVER HILL RD APT 3103
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-6533
Practice Address - Country:US
Practice Address - Phone:504-920-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT122239225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist