Provider Demographics
NPI:1033507199
Name:CHARLES, BETTY J (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:J
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MARIE ST
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:TX
Mailing Address - Zip Code:77371-2419
Mailing Address - Country:US
Mailing Address - Phone:936-203-8183
Mailing Address - Fax:
Practice Address - Street 1:41 MARIE ST
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:TX
Practice Address - Zip Code:77371-2419
Practice Address - Country:US
Practice Address - Phone:936-203-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2037869225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant