MEDICARE: INGRID ANNE THIES PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1147807	TX

General Provider Information

NPI Number	:	1528875937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID ANNE THIES PT

Provider Business Mailing Address
First Line	:	1356 FM 2673
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-4510
Country	:	US
Telephone Number	:	830-907-2145
Fax Number	:

Provider Business Practice Location Address
First Line	:	1356 FM 2673
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-4510
Country	:	US
Telephone Number	:	830-907-2145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	12/18/2024

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Directions to “ INGRID ANNE THIES PT” Practice Location

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