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General NPI Number Information
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NPI Number | 1104340058
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Entity Type | Organization
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Legal Business Name | TEXAS PROFESSIONAL FIRST ASSISTANCE,LLC
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 204 DEERCREEK LN
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City | LEANDER
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State | TX
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Zip | 78641-7819
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Country | US
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Telephone | 512-557-6433
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Fax |
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Provider Business Mailing Address
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Address Line | 204 DEERCREEK LN
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City | LEANDER
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State | TX
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Zip | 78641-7819
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Country | US
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Telephone | 512-557-6433
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY SHAWN DEHART
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Credential | CSFA
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Telephone | 512-557-6433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 87458
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License Number State | TX
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