Provider Demographics
NPI:1336852151
Name:MCBRIDE, MISTIE LEA (DPT)
Entity Type:Individual
Prefix:DR
First Name:MISTIE
Middle Name:LEA
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1761
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831-1761
Mailing Address - Country:US
Mailing Address - Phone:432-413-3900
Mailing Address - Fax:432-386-2847
Practice Address - Street 1:2600 HWY 118 NORTH
Practice Address - Street 2:PHYSICAL THERAPY DEPT
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830
Practice Address - Country:US
Practice Address - Phone:432-837-0220
Practice Address - Fax:432-837-0295
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist