MEDICARE: MARY Z KLEYPAS P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1040970	TX

General Provider Information

NPI Number	:	1043357338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY Z KLEYPAS P.T.

Provider Business Mailing Address
First Line	:	11334 CHEVY CHASE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-6402
Country	:	US
Telephone Number	:	281-589-9561
Fax Number	:

Provider Business Practice Location Address
First Line	:	12345 KATY FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77079-1503
Country	:	US
Telephone Number	:	281-679-5600
Fax Number	:	281-679-5591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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