Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2044816 | TX |
NPI | 1013160654 |
---|---|
Provider Name | Tammy Elaine Nevins |
First Address | Bowie, TX 76230-3115 |
Second Address | Bowie, TX 76230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 28/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2044816 | EXECUTIVE COUNCIL OF PHYSICAL THERAPY (01) | TX |