Provider Demographics
NPI:1255005641
Name:THOMAS, HAYLEY DESHON (PTA)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:DESHON
Last Name:THOMAS
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 1:1211 UNIVERSITY OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-3647
Mailing Address - Country:US
Mailing Address - Phone:903-292-7834
Mailing Address - Fax:
Practice Address - Street 1:3700 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4137
Practice Address - Country:US
Practice Address - Phone:979-774-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2163592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist