Provider Demographics
NPI:1497775860
Name:VALDEZ, MARIE LYNN (PT, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LYNN
Last Name:VALDEZ
Suffix:
Gender:F
Credentials:PT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 SAN JACINTO BLVD
Mailing Address - Street 2:STE. 108
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7535
Mailing Address - Country:US
Mailing Address - Phone:940-380-9111
Mailing Address - Fax:
Practice Address - Street 1:2318 SAN JACINTO BLVD
Practice Address - Street 2:STE. 108
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7535
Practice Address - Country:US
Practice Address - Phone:940-380-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1165980225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist