=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033691597
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARJORIE RAE OSTRANDER PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2018
-----------------------------------------------------
Last Update Date | 08/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 REUNION CT
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76048-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-573-3773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1513 AUGUSTA RD
-----------------------------------------------------
City | BENBROOK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76126-3836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-249-4265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1037281
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------