Provider Demographics
NPI:1578453668
Name:PEDRAZA, MIRTA NIKOLT (LMT, MLD CERTIFIED)
Entity type:Individual
Prefix:
First Name:MIRTA
Middle Name:NIKOLT
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:LMT, MLD CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-5282
Mailing Address - Country:US
Mailing Address - Phone:832-878-0858
Mailing Address - Fax:
Practice Address - Street 1:1032 E 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4907
Practice Address - Country:US
Practice Address - Phone:346-227-9774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT106231225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist