Provider Demographics
NPI:1962800763
Name:ATAY, MARICRIS JIMENEZ (RPT)
Entity type:Individual
Prefix:
First Name:MARICRIS
Middle Name:JIMENEZ
Last Name:ATAY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2029
Mailing Address - Country:US
Mailing Address - Phone:830-774-0698
Mailing Address - Fax:
Practice Address - Street 1:711 KINGS WAY
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2029
Practice Address - Country:US
Practice Address - Phone:830-774-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014007710225100000X
CO0012334225100000X
TX1269920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist