Provider Demographics
NPI:1043804024
Name:HOUSHOUR, DEVAN TAYLOR (PTA)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:TAYLOR
Last Name:HOUSHOUR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-541-5492
Mailing Address - Fax:
Practice Address - Street 1:2955 E STATE ST STE 5
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-9307
Practice Address - Country:US
Practice Address - Phone:234-575-0174
Practice Address - Fax:234-575-0177
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA012384225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant