Provider Demographics
NPI:1588814768
Name:WOERNER, MARIE BREITHAUPT (PT, DPT, WCS, CLT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:BREITHAUPT
Last Name:WOERNER
Suffix:
Gender:F
Credentials:PT, DPT, WCS, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12321
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-8321
Mailing Address - Country:US
Mailing Address - Phone:682-235-3816
Mailing Address - Fax:817-887-2719
Practice Address - Street 1:2901 CLEBURNE RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3400
Practice Address - Country:US
Practice Address - Phone:682-235-3816
Practice Address - Fax:817-887-2719
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199825402Medicaid
P00693133OtherRAILROAD MEDICARE
TX875T31OtherBCBS
TX875T31OtherBCBS
TXTXB158252Medicare PIN