Provider Demographics
NPI:1033691597
Name:OSTRANDER, MARJORIE RAE (PT)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:RAE
Last Name:OSTRANDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 AUGUSTA RD
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-3836
Mailing Address - Country:US
Mailing Address - Phone:817-249-4265
Mailing Address - Fax:
Practice Address - Street 1:600 REUNION CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1610
Practice Address - Country:US
Practice Address - Phone:817-573-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist