Provider Demographics
NPI:1255018289
Name:ARGUELLES, KASSIDY JEAN (PTA)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:JEAN
Last Name:ARGUELLES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KASSIDY
Other - Middle Name:JEAN
Other - Last Name:ARGUELLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:5220 SPRING VALLEY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2512
Mailing Address - Country:US
Mailing Address - Phone:214-446-1340
Mailing Address - Fax:214-466-1378
Practice Address - Street 1:5220 SPRING VALLEY RD STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-2512
Practice Address - Country:US
Practice Address - Phone:214-446-1340
Practice Address - Fax:214-466-1378
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2175244225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant