Provider Demographics
NPI:1508370099
Name:CANTERBERRY, THELMA CALDWELL
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:CALDWELL
Last Name:CANTERBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 HELMS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-1933
Mailing Address - Country:US
Mailing Address - Phone:832-446-7197
Mailing Address - Fax:281-260-8371
Practice Address - Street 1:1227 HELMS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-1933
Practice Address - Country:US
Practice Address - Phone:832-446-7197
Practice Address - Fax:281-260-8371
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty