Provider Demographics
NPI:1760963912
Name:ADIBI, HOUMAN (PTA)
Entity Type:Individual
Prefix:
First Name:HOUMAN
Middle Name:
Last Name:ADIBI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 S HIGHWAY 78
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4004
Mailing Address - Country:US
Mailing Address - Phone:972-303-8100
Mailing Address - Fax:
Practice Address - Street 1:721 S HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4004
Practice Address - Country:US
Practice Address - Phone:972-303-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2111317225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant