Provider Demographics
NPI:1346318680
Name:TANKSLEY, RHONDA HUDGINS (PT)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:HUDGINS
Last Name:TANKSLEY
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 1:1125 TOWN EAST MALL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4117
Mailing Address - Country:US
Mailing Address - Phone:972-613-4334
Mailing Address - Fax:972-613-4335
Practice Address - Street 1:1125 TOWN EAST MALL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4117
Practice Address - Country:US
Practice Address - Phone:972-613-4334
Practice Address - Fax:972-613-4335
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1092104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1092104OtherPHYSICAL THERAPY LICENSE
TX45-6797Medicare ID - Type UnspecifiedPROVIDER NUMBER