Healthcare Provider Details

I. General information

NPI: 1104181833
Provider Name (Legal Business Name): CHRIS JAY JALANDO-ON TABAREJO R.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2483 2ND ST SUITE B
EAGLE PASS TX
78852-4390
US

IV. Provider business mailing address

942 COLORADO ST APARTMENT G
EAGLE PASS TX
78852-4059
US

V. Phone/Fax

Practice location:
  • Phone: 830-776-5191
  • Fax: 830-776-5520
Mailing address:
  • Phone: 954-806-6948
  • Fax: 866-676-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1217320
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: