Provider Demographics
NPI:1457657520
Name:ILEY, MARIB BOYEA (LPTA)
Entity Type:Individual
Prefix:MS
First Name:MARIB
Middle Name:BOYEA
Last Name:ILEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 VISTA DEL NORTE
Mailing Address - Street 2:APARTMENT 1023
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-8038
Mailing Address - Country:US
Mailing Address - Phone:361-449-6330
Mailing Address - Fax:
Practice Address - Street 1:1020 CENTRAL PKWY S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5021
Practice Address - Country:US
Practice Address - Phone:210-798-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2072750225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant