MEDICARE: MS. MARY JANE STUBBS P.T., M.S.

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	2251G0304X	Geriatric Physical Therapist	1026730	TX

General Provider Information

NPI Number	:	1053469239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY JANE STUBBS P.T., M.S.

Provider Business Mailing Address
First Line	:	11711 MEMORIAL DR
Second Line	:	APT. 252
City	:	HOUSTON
State	:	TX
Zip	:	77024-7255
Country	:	US
Telephone Number	:	713-974-4087
Fax Number	:	713-974-4087

Provider Business Practice Location Address
First Line	:	1300 BINZ ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7016
Country	:	US
Telephone Number	:	713-285-1038
Fax Number	:

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

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	07/08/2007

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