Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1128510 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1128510 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1128510 | TX |
NPI | 1154566040 |
---|---|
Provider Name | Evette Marie Ramirez |
First Address | Dallas, TX 75267-4154 |
Second Address | Ennis, TX 75119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2008 |
Last Update Date | 08/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206204401 | (05) | TX |
815T61 | BCBS (01) | TX |
824T45 | BCBS (01) | TX |