Provider Demographics
NPI:1578513388
Name:PRATT, MARY LEE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LEE
Last Name:PRATT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6391 DEZAVALA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2143
Mailing Address - Country:US
Mailing Address - Phone:210-616-0629
Mailing Address - Fax:210-616-0916
Practice Address - Street 1:6391 DEZAVALA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2143
Practice Address - Country:US
Practice Address - Phone:210-616-0629
Practice Address - Fax:210-616-0916
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650248Medicare ID - Type Unspecified