Provider Demographics
NPI:1669410429
Name:HAMPTON, MARLA B (PT)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:B
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:DIANE
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 92248
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0103
Mailing Address - Country:US
Mailing Address - Phone:817-421-9111
Mailing Address - Fax:
Practice Address - Street 1:680 N CARROLL AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6411
Practice Address - Country:US
Practice Address - Phone:817-421-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6157OtherBCBS
TX8T6157OtherBCBS