Individual
MARISA KRISANANUWATARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12021 METRIC BLVD, AUSTIN, TX 78758-8616
(512) 228-3300
Mailing address
6805 LA SALLE DR, AUSTIN, TX 78723-2211
(151) 258-7447
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2113050
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2113050
PHYSICAL THERAPY ASSISTANT
TX
Enumeration date
09/12/2018
Last updated
09/12/2018
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