Provider Demographics
NPI:1205075009
Name:EBIZIE, TRYPHENA
Entity type:Individual
Prefix:
First Name:TRYPHENA
Middle Name:
Last Name:EBIZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16659 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 461
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2375
Mailing Address - Country:US
Mailing Address - Phone:281-340-9365
Mailing Address - Fax:
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 461
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-340-9365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1186503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist