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General NPI Number Information
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NPI Number | 1003516329
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Entity Type | Individual
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Provider Name | MRS. SHASTA HAYES PINA
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1110 JAMES ST
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City | WESLACO
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State | TX
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Zip | 78596-6659
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Country | US
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Telephone | 956-375-2216
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 987
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City | LA FERIA
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State | TX
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Zip | 78559-0987
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Country | US
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Telephone | 956-412-3269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2068857
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License Number State | TX
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