Provider Demographics
NPI:1952596504
Name:MAYNARD, FREYA H (PT)
Entity Type:Individual
Prefix:MISS
First Name:FREYA
Middle Name:H
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17111 GRANGER PATCH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-5854
Mailing Address - Country:US
Mailing Address - Phone:210-538-8250
Mailing Address - Fax:
Practice Address - Street 1:17111 GRANGER PATCH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-5854
Practice Address - Country:US
Practice Address - Phone:210-538-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160600225100000X
CA30253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist