Healthcare Provider Details

I. General information

NPI: 1578280723
Provider Name (Legal Business Name): MARIA DE JESUS MEJIA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/27/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 EAST 2ND STREET
DUMAS TX
79029
US

IV. Provider business mailing address

224 EAST 2ND STREET
DUMAS TX
79029
US

V. Phone/Fax

Practice location:
  • Phone: 806-934-6018
  • Fax: 806-934-7897
Mailing address:
  • Phone: 806-934-6018
  • Fax: 806-934-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2077372
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: