Provider Demographics
NPI:1790265049
Name:MUSTON, BONNIE MARIE (LPTA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:MARIE
Last Name:MUSTON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:MARIE
Other - Last Name:WUKSACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:15714 SEA LINER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-4311
Mailing Address - Country:US
Mailing Address - Phone:713-444-6642
Mailing Address - Fax:
Practice Address - Street 1:3921 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3307
Practice Address - Country:US
Practice Address - Phone:281-422-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2098901225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant