Provider Demographics
NPI:1154566040
Name:RAMIREZ, EVETTE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:EVETTE
Middle Name:MARIE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:DPT
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 674154
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4154
Mailing Address - Country:US
Mailing Address - Phone:214-369-8555
Mailing Address - Fax:214-369-2683
Practice Address - Street 1:2200 PHYSICIANS BOULEVARD
Practice Address - Street 2:STE D
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:972-878-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1128510225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX815T61OtherBCBS
TX206204401Medicaid
TX824T45OtherBCBS
TX824T45OtherBCBS
TX206204401Medicaid