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General NPI Number Information
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NPI Number | 1346923968
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Entity Type | Individual
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Provider Name | HAILEY DIERINGER PTA
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Gender | Female
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 744 S COLUMBIA DR
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City | WEST COLUMBIA
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State | TX
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Zip | 77486-3030
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Country | US
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Telephone | 979-345-2856
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Fax | 979-345-2350
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Provider Business Mailing Address
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Address Line | 4687 COUNTY ROAD 356
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City | BRAZORIA
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State | TX
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Zip | 77422-8108
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Country | US
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Telephone | 979-236-6908
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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 | 2162438
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License Number State | TX
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