Joe Petree, PTA

Individual provider Active NPI Physical Therapy Assistant · Cisco, TX

NPI 1831649433 · NPPES record last updated Oct 6, 2016

Key facts

NPI
1831649433
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
2114207 (TX)
Practice address
200 W 8TH St
Cisco, TX 76437-3023
Phone
(254) 631-7503
NPI assigned
Oct 6, 2016
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)
Yes

State licenses

LicenseStateTypeSpecialty
2114207TXMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 2114207 TX Yes

Addresses

Primary practice location

200 W 8TH St
Cisco, TX 76437-3023

Mailing address

200 W 8TH St
Cisco, TX 76437-3023
Phone (254) 631-7503

Other providers in Cisco, TX

All providers in Cisco, TX · Physical Therapy Assistant in Texas

Sources for this page

Verify at the official NPI Registry.