Provider Demographics
NPI:1104900349
Name:MAHLER, GERAN MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:GERAN
Middle Name:MICHELLE
Last Name:MAHLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GERAN
Other - Middle Name:
Other - Last Name:ETHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17827 BURNT LEAF LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2925
Mailing Address - Country:US
Mailing Address - Phone:281-608-3977
Mailing Address - Fax:
Practice Address - Street 1:16835 DEER CREEK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4968
Practice Address - Country:US
Practice Address - Phone:281-379-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1165663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist