Provider Demographics
NPI:1255415212
Name:BEHL, TANYA LOUISE MASAKO (PT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LOUISE MASAKO
Last Name:BEHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:LOUISE MASAKO
Other - Last Name:KING-BEHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:5915 WHITE OAK TRCE
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-5616
Mailing Address - Country:US
Mailing Address - Phone:805-484-5447
Mailing Address - Fax:805-484-2158
Practice Address - Street 1:18001 HIGHWAY 105 W STE 106
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-2881
Practice Address - Country:US
Practice Address - Phone:936-582-2464
Practice Address - Fax:936-582-4697
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33168225100000X
TX1338341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist