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General NPI Number Information
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NPI Number | 1407457674
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Entity Type | Individual
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Provider Name | JANIKA MAY PTA
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Gender | Female
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 120 MEADOW VIEW DR
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City | JUSTIN
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State | TX
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Zip | 76247-9639
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Country | US
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Telephone | 817-430-4417
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Fax |
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Provider Business Mailing Address
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Address Line | 2190 S UECKER LN APT 621
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City | LEWISVILLE
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State | TX
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Zip | 75067-7843
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Country | US
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Telephone | 224-280-0485
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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 | 2157450
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License Number State | TX
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