Provider Demographics
NPI:1538683776
Name:PENDARVIS, GINGER (PTA)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:PENDARVIS
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 1:626 KARABETH LN
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650-4121
Mailing Address - Country:US
Mailing Address - Phone:903-916-0367
Mailing Address - Fax:
Practice Address - Street 1:626 KARABETH LN
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650-4121
Practice Address - Country:US
Practice Address - Phone:903-916-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2082430225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant