Healthcare Provider Details

I. General information

NPI: 1487250759
Provider Name (Legal Business Name): MARIA CRYSTALLINE DIONISIO TOLENTINO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E. EDINBURG AVE. SUITE 1009
ELSA TX
78543
US

IV. Provider business mailing address

2101 N 23RD ST
MCALLEN TX
78501-6127
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-9131
  • Fax: 956-262-9232
Mailing address:
  • Phone: 956-687-4560
  • Fax: 956-618-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1340848
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: