Provider Demographics
NPI:1497637763
Name:MOONEY, TRINITY ANN
Entity type:Individual
Prefix:
First Name:TRINITY
Middle Name:ANN
Last Name:MOONEY
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 1:22394 COUNTY ROAD 3107
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-8904
Mailing Address - Country:US
Mailing Address - Phone:903-746-6796
Mailing Address - Fax:
Practice Address - Street 1:22394 COUNTY ROAD 3107
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-8904
Practice Address - Country:US
Practice Address - Phone:903-746-6796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2187739225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant