Provider Demographics
NPI:1760966618
Name:GENETA, ALLEN MIRANDA (PTA)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:MIRANDA
Last Name:GENETA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17114 SIMON CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2600
Mailing Address - Country:US
Mailing Address - Phone:832-686-1646
Mailing Address - Fax:
Practice Address - Street 1:1803 WESTCOTT AVE
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-4680
Practice Address - Country:US
Practice Address - Phone:281-329-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2091509225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant