Healthcare Provider Details

I. General information

NPI: 1093024168
Provider Name (Legal Business Name): GLORIA J. CISNEROS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 SPRINGFIELD AVE STE 101
LAREDO TX
78041-6712
US

IV. Provider business mailing address

6550 SPRINGFIELD AVE STE 101
LAREDO TX
78041-6712
US

V. Phone/Fax

Practice location:
  • Phone: 956-725-4555
  • Fax: 956-724-3555
Mailing address:
  • Phone: 956-725-4555
  • Fax: 956-724-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1013829
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: