Provider Demographics
NPI:1851609184
Name:PEPPER, TALIN MINTER (PT)
Entity Type:Individual
Prefix:
First Name:TALIN
Middle Name:MINTER
Last Name:PEPPER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 SW WILSHIRE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5300
Mailing Address - Country:US
Mailing Address - Phone:817-916-0878
Mailing Address - Fax:817-916-0879
Practice Address - Street 1:437 SW WILSHIRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5300
Practice Address - Country:US
Practice Address - Phone:817-916-0878
Practice Address - Fax:817-916-0879
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1200193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1G1846OtherMC PTAN
TX849T45OtherBLUE CROSS BLUE SHIELD
TXTXB134617Medicare PIN