Provider Demographics
NPI:1649245887
Name:DROST, MARY EASLEY (PT, DPT, CEEAA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EASLEY
Last Name:DROST
Suffix:
Gender:F
Credentials:PT, DPT, CEEAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 SAM HOUSTON DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-2238
Mailing Address - Country:US
Mailing Address - Phone:361-578-3513
Mailing Address - Fax:361-578-4623
Practice Address - Street 1:3412 SAM HOUSTON DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2238
Practice Address - Country:US
Practice Address - Phone:361-578-3513
Practice Address - Fax:361-578-4623
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1045961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
80207TOtherBLUE CROSS BLUE SHIELD
TX1921017Medicaid
4359847OtherAETNA