Provider Demographics
NPI:1386954501
Name:MCQUEEN, MARIAH JANNELLE (MPT)
Entity type:Individual
Prefix:MRS
First Name:MARIAH
Middle Name:JANNELLE
Last Name:MCQUEEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4738 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4416
Mailing Address - Country:US
Mailing Address - Phone:361-853-6100
Mailing Address - Fax:361-853-6106
Practice Address - Street 1:4738 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4416
Practice Address - Country:US
Practice Address - Phone:361-853-6100
Practice Address - Fax:361-853-6106
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist