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General NPI Number Information
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NPI Number | 1629950555
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Entity Type | Individual
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Provider Name | JULIA GRACE PEISHAN MERLET PTA
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 450 WOODLAND SQUARE BLVD
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City | CONROE
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State | TX
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Zip | 77384-2217
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Country | US
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Telephone | 936-235-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 103 FISH CREEK CT
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City | MONTGOMERY
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State | TX
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Zip | 77316-6844
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Country | US
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Telephone | 409-790-1302
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2187741
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License Number State | TX
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