Provider Demographics
NPI:1710664768
Name:FIELD-MACKALL, LA TONYA A (PTA, BS)
Entity Type:Individual
Prefix:
First Name:LA TONYA
Middle Name:A
Last Name:FIELD-MACKALL
Suffix:
Gender:F
Credentials:PTA, BS
Other - Prefix:
Other - First Name:LA TONYA
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16326 BERETTA CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-5320
Mailing Address - Country:US
Mailing Address - Phone:915-777-2846
Mailing Address - Fax:
Practice Address - Street 1:9940 W SAM HOUSTON PKWY S STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-5305
Practice Address - Country:US
Practice Address - Phone:832-300-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2172109225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant