Provider Demographics
NPI:1144917451
Name:ARIAS, MIRNA REBECKAH (PTA)
Entity type:Individual
Prefix:
First Name:MIRNA
Middle Name:REBECKAH
Last Name:ARIAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 LA SALLE OAKS
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-1383
Mailing Address - Country:US
Mailing Address - Phone:936-648-3946
Mailing Address - Fax:
Practice Address - Street 1:8717 HUMBLE WESTFIELD RD BLDG H
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4471
Practice Address - Country:US
Practice Address - Phone:281-548-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2174317225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant