Provider Demographics
NPI:1104185669
Name:GARRISON, DOROTHY (PTA)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:GARRISON
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:PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-9000
Mailing Address - Country:US
Mailing Address - Phone:972-771-0999
Mailing Address - Fax:972-771-2281
Practice Address - Street 1:301 S VIRGINIA ST
Practice Address - Street 2:STE B
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3717
Practice Address - Country:US
Practice Address - Phone:972-524-9100
Practice Address - Fax:972-524-9101
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2068019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165348701Medicaid
TX456643Medicare PIN