Provider Demographics
NPI:1558501338
Name:EUSERY, ANGELA YVONNE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:YVONNE
Last Name:EUSERY
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 1:2351 SHIREBROOK CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7815
Mailing Address - Country:US
Mailing Address - Phone:972-606-4988
Mailing Address - Fax:
Practice Address - Street 1:9441 LBJ FREEWAY #101
Practice Address - Street 2:SUPPLEMENTAL HEALTH CARE
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:866-575-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2030575225200000X
TXMT029946225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist