Basic Information
| Provider Information | |||||||||
| NPI: | 1679548382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARLEY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC, LAT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4607 BLUE ROSE CIR | ||||||||
| Address2: | |||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774592906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134108041 | ||||||||
| FaxNumber: | 2814940515 | ||||||||
| Practice Location | |||||||||
| Address1: | 15200 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 175 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774783845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814940550 | ||||||||
| FaxNumber: | 2814940515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT0707 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
ID Information
| ID | Type | State | Issuer | Description | AT0707 | 01 | TX | TEXAS DEPT. OF HEALTH LIC | OTHER |