Provider Demographics
NPI:1831558998
Name:GAMEZ, IRASEMA (PTA)
Entity type:Individual
Prefix:
First Name:IRASEMA
Middle Name:
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:IRASEMA
Other - Middle Name:
Other - Last Name:GAMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:; BUSINESS TOWER 1, SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7209
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:305 NE LOOP 820
Practice Address - Street 2:; BUSINESS TOWER 1, SUITE 200
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-7209
Practice Address - Country:US
Practice Address - Phone:817-292-8787
Practice Address - Fax:817-789-6849
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2072970225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant