Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1110336 | TX |
NPI | 1053737874 |
---|---|
Provider Name | Theresa Mai |
First Address | San Antonio, TX 78216-5832 |
Second Address | San Antonio, TX 78216-5832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2014 |
Last Update Date | 17/03/2014 |