Healthcare Provider Details

I. General information

NPI: 1114307667
Provider Name (Legal Business Name): MARGARET WURDEMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2015
Last Update Date: 05/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 LONGMIRE RD
CONROE TX
77304-1817
US

IV. Provider business mailing address

13302 NORTHSHORE DR
MONTGOMERY TX
77356-5329
US

V. Phone/Fax

Practice location:
  • Phone: 877-929-8875
  • Fax:
Mailing address:
  • Phone: 832-257-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1056141
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: