Provider Demographics
NPI:1023440179
Name:HINES, MICHAEL ASHTON (PTA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ASHTON
Last Name:HINES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3645
Mailing Address - Country:US
Mailing Address - Phone:318-557-9721
Mailing Address - Fax:
Practice Address - Street 1:9215 WHITE ROCK TRL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2593
Practice Address - Country:US
Practice Address - Phone:214-503-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2093736225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant