Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1169026 | TX |
NPI | 1003113416 |
---|---|
Provider Name | Marcille C Baumgartner |
First Address | Houston, TX 77030 |
Second Address | Houston, TX 77030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2011 |
Last Update Date | 16/04/2015 |