Provider Demographics
NPI:1306105648
Name:COATES, MARYBETH (PTA)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:COATES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16240 SEAHORSE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-6216
Mailing Address - Country:US
Mailing Address - Phone:281-892-9051
Mailing Address - Fax:
Practice Address - Street 1:16240 SEAHORSE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-6216
Practice Address - Country:US
Practice Address - Phone:281-892-9051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2072371225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant