Healthcare Provider Details

I. General information

NPI: 1588570238
Provider Name (Legal Business Name): DAVID ASAEL CANTU PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN BERNARDO AVE STE 108
LAREDO TX
78041-5718
US

IV. Provider business mailing address

4614 MIMS AVE
LAREDO TX
78041-3550
US

V. Phone/Fax

Practice location:
  • Phone: 956-284-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2187908
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: