Provider Demographics
NPI:1205365434
Name:WEBB, DEANNA KIMBERLY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:KIMBERLY
Last Name:WEBB
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:KIMBERLY
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12850 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1529
Mailing Address - Country:US
Mailing Address - Phone:972-404-3077
Mailing Address - Fax:972-404-1124
Practice Address - Street 1:12850 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1529
Practice Address - Country:US
Practice Address - Phone:972-404-3077
Practice Address - Fax:972-404-1124
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2017-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1288848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist