Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1219036 | TX |
N | 2251G0304X | Physical Therapist - Geriatrics | 1219036 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1219036 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1219036 | TX |
NPI | 1477806305 |
---|---|
Provider Name | Andrew Marek |
First Address | Wimberley, TX 78676-0019 |
Second Address | Wimberley, TX 78676-0019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2012 |
Last Update Date | 16/10/2012 |