Healthcare Provider Details

I. General information

NPI: 1063804300
Provider Name (Legal Business Name): MARIE INEZ WEBSTER PT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 MEADOW ISLE LN
DALLAS TX
75237-3215
US

IV. Provider business mailing address

2709 MEADOW ISLE LN
DALLAS TX
75237-3215
US

V. Phone/Fax

Practice location:
  • Phone: 214-298-3887
  • Fax: 817-977-0201
Mailing address:
  • Phone: 214-298-3887
  • Fax: 817-977-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1195461
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: