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General NPI Number Information
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NPI Number | 1407974231
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Entity Type | Individual
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Provider Name | TINA MOOTZ PT
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12890 HILLCREST RD SUITE 201
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City | DALLAS
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State | TX
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Zip | 75230-1504
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Country | US
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Telephone | 972-386-6310
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Fax | 972-404-9150
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Provider Business Mailing Address
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Address Line | 6302 CLEAR CREEK DR
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City | GARLAND
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State | TX
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Zip | 75044-3660
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Country | US
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Telephone | 972-386-6310
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Fax | 972-404-9150
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1062511
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License Number State | TX
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