| NPI | 1386943322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JEROME VIRAY GONZALES Owner/Manager 915-408-0699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: TX 1123313) |
| Additional Taxonomies | 261Q00000X (Licence: TX 111483) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2011-03-16 |