Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2016903 | TX |
NPI | 1003399965 |
---|---|
Provider Name | Deborah Sue Varner |
First Address | League City, TX 77573-2615 |
Second Address | League City, TX 77573-2615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2018 |
Last Update Date | 07/09/2018 |