Provider Demographics
NPI:1629378385
Name:AXELSON, MARNEE BAZANY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARNEE
Middle Name:BAZANY
Last Name:AXELSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 ST LUKES WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4103
Mailing Address - Country:US
Mailing Address - Phone:936-321-0333
Mailing Address - Fax:936-271-0333
Practice Address - Street 1:17350 ST LUKES WAY STE 100
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4103
Practice Address - Country:US
Practice Address - Phone:936-321-0333
Practice Address - Fax:936-271-0333
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2049780225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant