Provider Demographics
NPI:1598981672
Name:TATE, MARLA SUE (PT)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:SUE
Last Name:TATE
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 1:1290 S WILLIS ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4068
Mailing Address - Country:US
Mailing Address - Phone:325-690-5913
Mailing Address - Fax:325-690-1890
Practice Address - Street 1:1290 S WILLIS ST
Practice Address - Street 2:SUITE 209
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4068
Practice Address - Country:US
Practice Address - Phone:325-690-5913
Practice Address - Fax:325-690-1890
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist