Healthcare Provider Details

I. General information

NPI: 1184840407
Provider Name (Legal Business Name): GRACIELA FALCON-MONTOYA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ELIZABETH ST
CORPUS CHRISTI TX
78404-2235
US

IV. Provider business mailing address

3333 S ALAMEDA ST APT 12H
CORPUS CHRISTI TX
78411-1847
US

V. Phone/Fax

Practice location:
  • Phone: 361-881-3518
  • Fax:
Mailing address:
  • Phone: 361-814-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2018107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: