Provider Demographics
NPI:1780800466
Name:PAVLASEK, MARTHA ANNE (PT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
Last Name:PAVLASEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:A
Other - Last Name:PAVLASEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:254-215-9722
Practice Address - Street 1:900 SCOTT AND WHITE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6419
Practice Address - Country:US
Practice Address - Phone:979-207-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist