Provider Demographics
NPI:1548831779
Name:MARKS, EBONY (LMT)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 BARKER CYPRESS RD APT 2607
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-4574
Mailing Address - Country:US
Mailing Address - Phone:832-647-0136
Mailing Address - Fax:
Practice Address - Street 1:947 GESSNER RD
Practice Address - Street 2:STE B-275, UNIT 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2516
Practice Address - Country:US
Practice Address - Phone:832-827-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021016587225700000X
TXMT135251225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist