Provider Demographics
NPI:1295039303
Name:HUSTON, TONYA (PT)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:HUSTON
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 1766
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:TX
Mailing Address - Zip Code:76856-1766
Mailing Address - Country:US
Mailing Address - Phone:512-757-4178
Mailing Address - Fax:
Practice Address - Street 1:4818 NIGHT SKY TRAIL
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TX
Practice Address - Zip Code:76856-1766
Practice Address - Country:US
Practice Address - Phone:512-757-4178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist