Provider Demographics
NPI:1023569118
Name:MARIN, PRISCILLA (DPT)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ZAMORA MEDICAL CIR # 3
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5485
Mailing Address - Country:US
Mailing Address - Phone:830-757-0900
Mailing Address - Fax:
Practice Address - Street 1:126 ZAMORA MEDICAL CIR # 3
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5485
Practice Address - Country:US
Practice Address - Phone:830-757-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist