Healthcare Provider Details

I. General information

NPI: 1740762137
Provider Name (Legal Business Name): MEELA MEJIA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S MAIN ST
WINNSBORO TX
75494-3226
US

IV. Provider business mailing address

3697 BENTRIDGE CT
TYLER TX
75707-0005
US

V. Phone/Fax

Practice location:
  • Phone: 903-342-6790
  • Fax:
Mailing address:
  • Phone: 956-451-4491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2061277
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: