MEDICARE: MRS. AGNES TECSON MASIGLAT 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	1091304	TX
2	225100000X	Physical Therapist	3508	NC

General Provider Information

NPI Number	:	1740210954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AGNES TECSON MASIGLAT PT

Provider Business Mailing Address
First Line	:	4271 NORTHVALE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1132
Country	:	US
Telephone Number	:	281-444-9013
Fax Number	:	713-490-1208

Provider Business Practice Location Address
First Line	:	1414 SOUTH LOOP W
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77054-3825
Country	:	US
Telephone Number	:	713-797-6106
Fax Number	:	713-490-1208

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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