Healthcare Provider Details

I. General information

NPI: 1164127056
Provider Name (Legal Business Name): JOHNATHAN JAMES ACOSTA PINON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18951 N MEMORIAL DR
HUMBLE TX
77338-4217
US

IV. Provider business mailing address

2731 SPRING COLONY DR
SPRING TX
77386-2364
US

V. Phone/Fax

Practice location:
  • Phone: 281-540-7700
  • Fax:
Mailing address:
  • Phone: 832-398-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2163051
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: