Provider Demographics
NPI:1922250307
Name:MARSHALL, BETTY JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JANE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:PATRICK
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:14019 SOUTHWEST FWY STE 301
Mailing Address - Street 2:PMB 244
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3551
Mailing Address - Country:US
Mailing Address - Phone:713-249-7655
Mailing Address - Fax:
Practice Address - Street 1:14019 SOUTHWEST FWY STE 301
Practice Address - Street 2:PMB 244
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3551
Practice Address - Country:US
Practice Address - Phone:713-249-7655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34984171W00000X
FLPT21386171W00000X
TX1006468171W00000X
CO9599171W00000X
NC9413171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor