Provider Demographics
NPI:1831670298
Name:DAMSTRA, MADISSON SHEA (PTA)
Entity Type:Individual
Prefix:
First Name:MADISSON
Middle Name:SHEA
Last Name:DAMSTRA
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 1:7311 E STONE HILL CT
Mailing Address - Street 2:
Mailing Address - City:LIPAN
Mailing Address - State:TX
Mailing Address - Zip Code:76462-6800
Mailing Address - Country:US
Mailing Address - Phone:817-226-8323
Mailing Address - Fax:
Practice Address - Street 1:801 CALINCO DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-4000
Practice Address - Country:US
Practice Address - Phone:817-505-7833
Practice Address - Fax:479-595-0581
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2122225225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant