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General NPI Number Information
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NPI Number | 1770633984
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Entity Type | Individual
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Provider Name | MARCY MAINES P.T
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 12/05/2014
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Provider Practice Location Address
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Address Line | 206 S STATE HIGHWAY 342 SUITE F
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City | RED OAK
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State | TX
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Zip | 75154-6522
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Country | US
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Telephone | 469-373-2967
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Fax | 888-614-1885
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Provider Business Mailing Address
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Address Line | 206 S STATE HIGHWAY 342 SUITE F
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City | RED OAK
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State | TX
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Zip | 75154-6522
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Country | US
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Telephone | 469-373-2967
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Fax | 888-614-1885
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1133775
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License Number State | TX
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