Provider Demographics
NPI:1902188121
Name:ROBERSON, MYAH ARLETTE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MYAH
Middle Name:ARLETTE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8172
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77288-8172
Mailing Address - Country:US
Mailing Address - Phone:713-456-0626
Mailing Address - Fax:
Practice Address - Street 1:5419 ENNIS AVENUE
Practice Address - Street 2:#4
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-456-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112531172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112531OtherMECHANO THERAPIST