Provider Demographics
NPI:1033102827
Name:HUGHES, ARDRA DEA (PT)
Entity Type:Individual
Prefix:
First Name:ARDRA
Middle Name:DEA
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PT
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 2427
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-1906
Mailing Address - Country:US
Mailing Address - Phone:830-997-2001
Mailing Address - Fax:830-997-0781
Practice Address - Street 1:1316 HWY 16 S
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5058
Practice Address - Country:US
Practice Address - Phone:830-997-2001
Practice Address - Fax:830-997-0781
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ46313Medicare UPIN
TX8D6381Medicare ID - Type Unspecified
TXP00360894Medicare PIN