Provider Demographics
NPI:1942309000
Name:PACE, MICHAEL B (ATC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:PACE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19206 CANDLEBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-5202
Mailing Address - Country:US
Mailing Address - Phone:281-288-4526
Mailing Address - Fax:281-355-2112
Practice Address - Street 1:19428 INTERSTATE 45
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-2910
Practice Address - Country:US
Practice Address - Phone:281-355-2169
Practice Address - Fax:281-355-3020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT0467251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)