Basic Information
Provider Information
NPI: 1033431192
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUNOZ
FirstName: ALEXANDRO
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1900 S. JACKSON
Address2: STE. 2-3
City: MCALLEN
State: TX
PostalCode: 78503
CountryCode: US
TelephoneNumber: 9566304400
FaxNumber: 9566304447
Practice Location
Address1: 1900 S. JACKSON
Address2: STE. 2-3
City: MCALLEN
State: TX
PostalCode: 78503
CountryCode: US
TelephoneNumber: 9566304400
FaxNumber: 9566304447
Other Information
ProviderEnumerationDate: 02/17/2010
LastUpdateDate: 02/17/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000X2054201TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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