Provider Demographics
NPI:1659015220
Name:KUNNEL, SHEBA TITUS (PTA)
Entity Type:Individual
Prefix:
First Name:SHEBA
Middle Name:TITUS
Last Name:KUNNEL
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 1:1109 SANDERLING DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2675
Mailing Address - Country:US
Mailing Address - Phone:972-302-1295
Mailing Address - Fax:
Practice Address - Street 1:3272 N GARLAND AVE
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3207
Practice Address - Country:US
Practice Address - Phone:972-675-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2091250225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant