Provider Demographics
NPI:1144701558
Name:RATLIFF, TANGELA SUE (PTA)
Entity type:Individual
Prefix:
First Name:TANGELA
Middle Name:SUE
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TANGELA
Other - Middle Name:
Other - Last Name:HUTCHINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1959 HAMBLETON DR
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-9744
Mailing Address - Country:US
Mailing Address - Phone:254-265-2570
Mailing Address - Fax:
Practice Address - Street 1:1959 HAMBLETON DR
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655-9744
Practice Address - Country:US
Practice Address - Phone:214-356-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2045730225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant