Healthcare Provider Details

I. General information

NPI: 1932624095
Provider Name (Legal Business Name): JOEL HOMERO OBREGON PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2017
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6014 45TH ST
LUBBOCK TX
79407-3773
US

IV. Provider business mailing address

1727 W SAGE RD
KINGSVILLE TX
78363-2696
US

V. Phone/Fax

Practice location:
  • Phone: 806-780-7433
  • Fax: 806-780-7434
Mailing address:
  • Phone: 361-522-7401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1293936
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: