Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2082671 | TX |
NPI | 1003487034 |
---|---|
Provider Name | Michelle Renea Maston |
First Address | San Antonio, TX 78261-2578 |
Second Address | San Antonio, TX 78261-2578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2021 |
Last Update Date | 09/07/2021 |