Provider Demographics
NPI:1386496388
Name:TARDY, DEVAN N
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:N
Last Name:TARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 RIO ALAMO ST
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4003
Mailing Address - Country:US
Mailing Address - Phone:832-775-5784
Mailing Address - Fax:
Practice Address - Street 1:5505 RIO ALAMO ST
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-4003
Practice Address - Country:US
Practice Address - Phone:832-775-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2148406225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant