Provider Demographics
NPI:1013498179
Name:HIX, TERA (PTA)
Entity type:Individual
Prefix:MRS
First Name:TERA
Middle Name:
Last Name:HIX
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:TERA
Other - Middle Name:
Other - Last Name:KEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2212 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-1718
Mailing Address - Country:US
Mailing Address - Phone:254-223-3313
Mailing Address - Fax:
Practice Address - Street 1:300 S HIGHWAY 36 BYP N
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-2764
Practice Address - Country:US
Practice Address - Phone:254-865-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2073349225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant