Provider Demographics
NPI:1033283957
Name:FOREMAN, MARJORIE WEAVER (MPT)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:WEAVER
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660046
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0046
Mailing Address - Country:US
Mailing Address - Phone:214-369-8555
Mailing Address - Fax:214-369-2683
Practice Address - Street 1:8251 BEDFORD EULESS RD
Practice Address - Street 2:STE 210
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7200
Practice Address - Country:US
Practice Address - Phone:817-656-7827
Practice Address - Fax:817-485-0546
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1162597OtherPHYSICAL THERAPIST LICENS