Provider Demographics
NPI:1861174674
Name:BARRIENTOS QUERALES, MARISOL RAQUEL (PTA)
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:RAQUEL
Last Name:BARRIENTOS QUERALES
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 1:29006 CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1016
Mailing Address - Country:US
Mailing Address - Phone:281-794-1368
Mailing Address - Fax:
Practice Address - Street 1:25018 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2722
Practice Address - Country:US
Practice Address - Phone:281-364-9695
Practice Address - Fax:888-294-6679
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2147391225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant