MEDICARE: MARIBEL ONTIVEROS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1051142	TX

General Provider Information

NPI Number	:	1114129863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIBEL ONTIVEROS PT

Provider Business Mailing Address
First Line	:	17616 WINDFLOWER WAY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5318
Country	:	US
Telephone Number	:	972-679-3261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 COIT RD
Second Line	:	SUITE 101A
City	:	PLANO
State	:	TX
Zip	:	75075-4750
Country	:	US
Telephone Number	:	972-964-6633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	10/31/2023

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Directions to “ MARIBEL ONTIVEROS PT” Practice Location

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