Provider Demographics
NPI:1205936929
Name:HOLLIS, LETA (PTA)
Entity type:Individual
Prefix:MRS
First Name:LETA
Middle Name:
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:LETA
Other - Middle Name:
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:353 VZCR 1519
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140
Mailing Address - Country:US
Mailing Address - Phone:903-963-4108
Mailing Address - Fax:903-962-3082
Practice Address - Street 1:102 E GRAND PLZ
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1932
Practice Address - Country:US
Practice Address - Phone:903-962-7901
Practice Address - Fax:903-962-3082
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2024180225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant