Provider Demographics
NPI:1083997894
Name:MA, DUSTIN
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1526
Mailing Address - Country:US
Mailing Address - Phone:713-779-5800
Mailing Address - Fax:713-779-5885
Practice Address - Street 1:4009 BELLAIRE BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1168
Practice Address - Country:US
Practice Address - Phone:713-839-7800
Practice Address - Fax:713-839-7931
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1209017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist