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General NPI Number Information
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NPI Number | 1255005641
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Entity Type | Individual
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Provider Name | HAYLEY DESHON THOMAS PTA
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Gender | Female
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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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 |
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Provider Business Mailing Address
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Address Line | 1211 UNIVERSITY OAKS BLVD
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City | COLLEGE STATION
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State | TX
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Zip | 77840-3647
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Country | US
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Telephone | 903-292-7834
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2163592
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License Number State | TX
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