Provider Demographics
NPI:1477067270
Name:GILADA, MARIE R (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:R
Last Name:GILADA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11481 TOEPPERWEIN RD STE 1201
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3146
Mailing Address - Country:US
Mailing Address - Phone:210-599-8903
Mailing Address - Fax:210-599-9035
Practice Address - Street 1:11481 TOEPPERWEIN RD STE 1201
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3146
Practice Address - Country:US
Practice Address - Phone:210-599-8903
Practice Address - Fax:210-599-9035
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1293577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty