Provider Demographics
NPI:1871090738
Name:WIDWANI, SALIMA A (PTA)
Entity type:Individual
Prefix:
First Name:SALIMA
Middle Name:A
Last Name:WIDWANI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E ASH LN APT 1506
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-4761
Mailing Address - Country:US
Mailing Address - Phone:682-472-8203
Mailing Address - Fax:
Practice Address - Street 1:419 S COCKRELL HILL RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4939
Practice Address - Country:US
Practice Address - Phone:682-472-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2134436225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant