Provider Demographics
NPI:1538271895
Name:TAL, PHYLLIS E (PT)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:E
Last Name:TAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:PHYLLIS
Other - Middle Name:E
Other - Last Name:TAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JD
Mailing Address - Street 1:1530 HAVEN LOCK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-4208
Mailing Address - Country:US
Mailing Address - Phone:281-920-4399
Mailing Address - Fax:
Practice Address - Street 1:1530 HAVEN LOCK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-4208
Practice Address - Country:US
Practice Address - Phone:281-920-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1103125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist