Provider Demographics
NPI:1730843905
Name:WEST, MISTY LEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:LEE
Last Name:WEST
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-9468
Mailing Address - Country:US
Mailing Address - Phone:512-757-1529
Mailing Address - Fax:
Practice Address - Street 1:802 LEAH AVE
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7951
Practice Address - Country:US
Practice Address - Phone:512-757-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1333864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist