Provider Demographics
NPI:1811669880
Name:HIXSON, THERESA CATHLEEN (PTA)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:CATHLEEN
Last Name:HIXSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 PROFESSIONAL PL STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-8140
Mailing Address - Country:US
Mailing Address - Phone:719-227-7079
Mailing Address - Fax:719-227-7061
Practice Address - Street 1:2955 PROFESSIONAL PL STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-8140
Practice Address - Country:US
Practice Address - Phone:719-227-7079
Practice Address - Fax:719-227-7061
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000016225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant