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NPI Code Detail

MEDICARE: GLORIA J. CISNEROS PT

MEDICARE: GLORIA J. CISNEROS PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical Therapist1013829TX

General Provider Information

NPI Number : 1093024168
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLORIA J. CISNEROS PT
Provider Business Mailing Address
First Line : 6550 SPRINGFIELD AVE STE 101
Second Line :
City : LAREDO
State : TX
Zip : 78041-6712
Country : US
Telephone Number : 956-725-4555
Fax Number : 956-724-3555
Provider Business Practice Location Address
First Line : 6550 SPRINGFIELD AVE STE 101
Second Line :
City : LAREDO
State : TX
Zip : 78041-6712
Country : US
Telephone Number : 956-725-4555
Fax Number : 956-724-3555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2010
Last Update Date : 10/06/2010

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Directions to “ GLORIA J. CISNEROS PT” Practice Location

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