Provider Demographics
NPI:1740516483
Name:HYDE, PRENTIS (PT)
Entity type:Individual
Prefix:
First Name:PRENTIS
Middle Name:
Last Name:HYDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 ARLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3203
Mailing Address - Country:US
Mailing Address - Phone:469-964-1226
Mailing Address - Fax:
Practice Address - Street 1:833 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3203
Practice Address - Country:US
Practice Address - Phone:469-964-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist