Provider Demographics
NPI:1881002079
Name:RAMIREZ, DEISY JOVANA (PTA)
Entity type:Individual
Prefix:MRS
First Name:DEISY
Middle Name:JOVANA
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:DEISY
Other - Middle Name:JOVANA
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:305 NE LOOP 820; BUSINESS TOWER 1, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:817-789-6849
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-353-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2106006225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant