Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2090916 | TX |
NPI | 1003165515 |
---|---|
Provider Name | Tanya Rae Parra |
First Address | Fort Worth, TX 76133-1931 |
Second Address | El Paso, TX 79925-2155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2012 |
Last Update Date | 30/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149984001 | (05) | TX |
207164901 | (05) | TX |