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General NPI Number Information
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NPI Number | 1134329246
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Entity Type | Individual
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Provider Name | MANDI JO FOX PTA
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Gender | Female
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 3700 CROSS PARK DR
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City | BRYAN
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State | TX
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Zip | 77802-4137
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Country | US
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Telephone | 979-774-9958
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Fax | 979-774-9978
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Provider Business Mailing Address
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Address Line | 3700 CROSS PARK DR
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City | BRYAN
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State | TX
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Zip | 77802-4137
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Country | US
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Telephone | 979-774-9958
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Fax | 979-774-9978
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2062539
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License Number State | TX
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