Healthcare Provider Details

I. General information

NPI: 1215389671
Provider Name (Legal Business Name): MIGUEL VALLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 SAN JACINTO BLVD STE 108
DENTON TX
76205-7535
US

IV. Provider business mailing address

10317 W CLOVER LN
FORNEY TX
75126-7906
US

V. Phone/Fax

Practice location:
  • Phone: 940-380-9111
  • Fax: 940-380-9112
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: