Provider Demographics
NPI:1942956081
Name:NEVINS, RALPH WAYNE III (MPT)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:WAYNE
Last Name:NEVINS
Suffix:III
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:NEVINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-541-5492
Mailing Address - Fax:
Practice Address - Street 1:13901 MIDWAY RD STE 106
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-4388
Practice Address - Country:US
Practice Address - Phone:214-427-5772
Practice Address - Fax:214-989-7058
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist