MEDICARE: MS. ADELL E. TARDY ASSOCIATES DEGREE

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	225200000X	Physical Therapy Assistant	2002788	TX

General Provider Information

NPI Number	:	1740394279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADELL E. TARDY ASSOCIATES DEGREE

Provider Business Mailing Address
First Line	:	6034 WESTOVER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-1234
Country	:	US
Telephone Number	:	713-794-7192
Fax Number	:	713-794-7631

Provider Business Practice Location Address
First Line	:	6034 WESTOVER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77033-1234
Country	:	US
Telephone Number	:	713-794-7192
Fax Number	:	713-794-7631

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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