MEDICARE: MS. MARY BETH PACE MSPT DC

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	1043552	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	611881300	OTHER	TX	OWCP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8T1420	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1245331966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY BETH PACE MSPT DC

Provider Business Mailing Address
First Line	:	6731 STELLA LINK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-4342
Country	:	US
Telephone Number	:	713-662-9900
Fax Number	:	713-662-9919

Provider Business Practice Location Address
First Line	:	6731 STELLA LINK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-4342
Country	:	US
Telephone Number	:	713-662-9900
Fax Number	:	713-662-9919

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/03/2024

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