Provider Demographics
NPI:1396227492
Name:HARDESTY, WILMA JEANNETTE (PT DPT)
Entity Type:Individual
Prefix:DR
First Name:WILMA
Middle Name:JEANNETTE
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 RURAL LN
Mailing Address - Street 2:
Mailing Address - City:SWEENY
Mailing Address - State:TX
Mailing Address - Zip Code:77480-2202
Mailing Address - Country:US
Mailing Address - Phone:281-943-9997
Mailing Address - Fax:
Practice Address - Street 1:109 N MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:SWEENY
Practice Address - State:TX
Practice Address - Zip Code:77480-3400
Practice Address - Country:US
Practice Address - Phone:979-548-3383
Practice Address - Fax:979-548-4701
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist