Provider Demographics
NPI:1245709609
Name:TIRADO, DAMARIS YANIRA
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:YANIRA
Last Name:TIRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6173 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-4800
Mailing Address - Country:US
Mailing Address - Phone:254-421-4831
Mailing Address - Fax:
Practice Address - Street 1:6173 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-4800
Practice Address - Country:US
Practice Address - Phone:254-421-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2143278225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant