Provider Demographics
NPI:1942551734
Name:DORITY, MINDY NICOLE (PT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:NICOLE
Last Name:DORITY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N COLLEGIATE DR
Mailing Address - Street 2:SUITE 550
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-1494
Mailing Address - Country:US
Mailing Address - Phone:903-784-3173
Mailing Address - Fax:903-784-7912
Practice Address - Street 1:201 N COLLEGIATE DR
Practice Address - Street 2:SUITE 550
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-1494
Practice Address - Country:US
Practice Address - Phone:903-784-3173
Practice Address - Fax:903-784-7912
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist