Losson Demel, PHYSICAL THERAPIST
Individual provider Active NPI Physical Therapist · Hereford, TX
NPI 1326514480 · NPPES record last updated May 15, 2019
Key facts
- NPI
- 1326514480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2138499 (TX)
- Practice address
- 725 Thunderbird St
Hereford, TX 79045-4821 - Phone
- (817) 600-4442
- NPI assigned
- Oct 16, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2138499 | TX | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | |||
| Physical Therapist | 225100000X | 2138499 | TX | Yes |
Addresses
Primary practice location
725 Thunderbird St
Hereford, TX 79045-4821
Mailing address
725 Thunderbird St
Hereford, TX 79045-4821
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2138499 | Other | TX | PTA |
Other providers in Hereford, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.