Healthcare Provider Details

I. General information

NPI: 1962454066
Provider Name (Legal Business Name): BROWNSVILLE BACK SCHOOL, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 W ALTON GLOOR BLVD
BROWNSVILLE TX
78520-9277
US

IV. Provider business mailing address

942 WILDROSE LN
BROWNSVILLE TX
78520-8817
US

V. Phone/Fax

Practice location:
  • Phone: 956-350-2143
  • Fax: 956-350-9480
Mailing address:
  • Phone: 956-541-6725
  • Fax: 956-541-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1157126
License Number StateTX

VIII. Authorized Official

Name: RAQUEL ACEVEDO
Title or Position: ADMINISTRATOR
Credential:
Phone: 956-541-6725