MEDICARE: MR. EDWARD RAMOS DELACRUZ PTA

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
1	225200000X	Physical Therapy Assistant	2020848	TX

General Provider Information

NPI Number	:	1952727760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD RAMOS DELACRUZ PTA

Provider Business Mailing Address
First Line	:	8603 BELHAVEN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-6039
Country	:	US
Telephone Number	:	210-639-3903
Fax Number	:

Provider Business Practice Location Address
First Line	:	8603 BELHAVEN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-6039
Country	:	US
Telephone Number	:	210-639-3903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2014
Last Update Date	:	03/17/2014

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