Provider Demographics
NPI:1043510654
Name:MANUEL, REBECCA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:MANUEL
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 1:31 N MISTY CANYON PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3533
Mailing Address - Country:US
Mailing Address - Phone:832-260-8993
Mailing Address - Fax:832-426-0299
Practice Address - Street 1:31 N MISTY CANYON PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77385-3533
Practice Address - Country:US
Practice Address - Phone:832-260-8993
Practice Address - Fax:832-426-0299
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2045540225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2045540OtherEXECUTIVE COUNCIL OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS