Provider Demographics
NPI:1114915188
Name:ENDSLEY, JOANNA RENEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:RENEE
Last Name:ENDSLEY
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 130214
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0214
Mailing Address - Country:US
Mailing Address - Phone:903-245-7701
Mailing Address - Fax:903-561-6281
Practice Address - Street 1:3202 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5143
Practice Address - Country:US
Practice Address - Phone:903-753-6635
Practice Address - Fax:903-753-1114
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611551Medicare ID - Type UnspecifiedPHYSICAL THERAPY