Healthcare Provider Details

I. General information

NPI: 1538282348
Provider Name (Legal Business Name): HELEN ANN SEVERSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 SAN JACINTO BLVD
DENTON TX
76205-7535
US

IV. Provider business mailing address

2203 RYAN RDG
GRAPEVINE TX
76051-2731
US

V. Phone/Fax

Practice location:
  • Phone: 940-380-9111
  • Fax: 940-380-9112
Mailing address:
  • Phone: 817-488-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2052999
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: