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General NPI Number Information
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NPI Number | 1417675547
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Entity Type | Individual
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Provider Name | THOMAS SETH AMMON PTA
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Gender | Male
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 140 W ELDRED ST STE 101
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City | BURLESON
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State | TX
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Zip | 76028-4282
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Country | US
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Telephone | 817-888-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 7913 LAZY BROOK DR
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City | WATAUGA
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State | TX
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Zip | 76148-1516
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Country | US
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Telephone |
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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 | 2147075
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License Number State | TX
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