Healthcare Provider Details

I. General information

NPI: 1043721962
Provider Name (Legal Business Name): ARISTA GRACE HOTT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 RICHMOND PL UNIT B
TEXARKANA TX
75503-0002
US

IV. Provider business mailing address

4107 RICHMOND PL UNIT B
TEXARKANA TX
75503-0002
US

V. Phone/Fax

Practice location:
  • Phone: 903-204-7662
  • Fax:
Mailing address:
  • Phone: 903-204-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1391176
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: