Provider Demographics
NPI:1093020208
Name:FLEMING, MARCY BETH (PT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:BETH
Last Name:FLEMING
Suffix:
Gender:F
Credentials:PT, LAT, ATC
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:
Other - Last Name:FRASIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7401 FM 1237
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:TX
Mailing Address - Zip Code:76557-3249
Mailing Address - Country:US
Mailing Address - Phone:254-493-7131
Mailing Address - Fax:
Practice Address - Street 1:2300 S CLEAR CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4985
Practice Address - Country:US
Practice Address - Phone:254-554-2637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174H00000X
TXAT28922255A2300X
TX1314682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174H00000XOther Service ProvidersHealth Educator
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer