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NPI Code Detail

MEDICARE: BERVEY O BAILEY PTA

MEDICARE: BERVEY O BAILEY PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2058248TX

General Provider Information

NPI Number : 1164643342
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERVEY O BAILEY PTA
Provider Business Mailing Address
First Line : 5800 PRESTON OAKS RD
Second Line : APT.# 2052
City : DALLAS
State : TX
Zip : 75254
Country : US
Telephone Number : 580-917-3553
Fax Number :
Provider Business Practice Location Address
First Line : 5800 PRESTON OAKS RD
Second Line : APT.# 2052
City : DALLAS
State : TX
Zip : 75254
Country : US
Telephone Number : 580-917-3553
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 07/08/2007

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Directions to “ BERVEY O BAILEY PTA” Practice Location

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