Provider Demographics
NPI:1336866946
Name:GENAVIA, MARIA BERNADETTE DELA ROSA
Entity Type:Individual
Prefix:
First Name:MARIA BERNADETTE
Middle Name:DELA ROSA
Last Name:GENAVIA
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 1:10425 SHERWIN PASS DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4155
Mailing Address - Country:US
Mailing Address - Phone:805-890-6748
Mailing Address - Fax:
Practice Address - Street 1:151 COMMERCE GREEN BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3573
Practice Address - Country:US
Practice Address - Phone:281-903-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2167003225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant