Provider Demographics
NPI:1063804300
Name:WEBSTER, MARIE INEZ (PT DPT)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:INEZ
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 MEADOW ISLE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3215
Mailing Address - Country:US
Mailing Address - Phone:214-298-3887
Mailing Address - Fax:817-977-0201
Practice Address - Street 1:2709 MEADOW ISLE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3215
Practice Address - Country:US
Practice Address - Phone:214-298-3887
Practice Address - Fax:817-977-0201
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1195461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist