Provider Demographics
NPI:1124117288
Name:PHENIX, MOHNA GAIL (PT)
Entity type:Individual
Prefix:MRS
First Name:MOHNA
Middle Name:GAIL
Last Name:PHENIX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MOHNA
Other - Middle Name:GAIL
Other - Last Name:ZINTGRAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MPT
Mailing Address - Street 1:17350 ST LUKES WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4100
Mailing Address - Country:US
Mailing Address - Phone:936-321-0333
Mailing Address - Fax:936-271-0333
Practice Address - Street 1:17350 ST LUKES WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4100
Practice Address - Country:US
Practice Address - Phone:936-321-0333
Practice Address - Fax:936-271-0333
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133981225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20101183Medicaid
TX20101183Medicaid