Healthcare Provider Details

I. General information

NPI: 1205936929
Provider Name (Legal Business Name): LETA HOLLIS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LETA GRACE PTA

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E GRAND PLZ
GRAND SALINE TX
75140-1932
US

IV. Provider business mailing address

353 VZCR 1519
GRAND SALINE TX
75140
US

V. Phone/Fax

Practice location:
  • Phone: 903-962-7901
  • Fax: 903-962-3082
Mailing address:
  • Phone: 903-963-4108
  • Fax: 903-962-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2024180
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: