Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1026730 | TX |
NPI | 1053469239 |
---|---|
Provider Name | Ms. Mary Jane Stubbs |
First Address | Houston, TX 77024-7255 |
Second Address | Houston, TX 77004-7016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2007 |
Last Update Date | 08/07/2007 |