Provider Demographics
NPI:1922611425
Name:AMMON, RAYMI DENISE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RAYMI
Middle Name:DENISE
Last Name:AMMON
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 1:2700 W PLEASANT RUN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1079
Mailing Address - Country:US
Mailing Address - Phone:817-203-0914
Mailing Address - Fax:817-203-6031
Practice Address - Street 1:2700 W PLEASANT RUN RD STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1079
Practice Address - Country:US
Practice Address - Phone:817-203-0914
Practice Address - Fax:817-203-6031
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2028470225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2028470OtherECPTOTE