Provider Demographics
NPI:1982038915
Name:SQUIRES, TOBEN RICHARD (PTA)
Entity Type:Individual
Prefix:MR
First Name:TOBEN
Middle Name:RICHARD
Last Name:SQUIRES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13375 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8406
Mailing Address - Country:US
Mailing Address - Phone:928-607-2190
Mailing Address - Fax:
Practice Address - Street 1:2990 LAUREL ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-2104
Practice Address - Country:US
Practice Address - Phone:409-861-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2098388225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant