Healthcare Provider Details

I. General information

NPI: 1932715455
Provider Name (Legal Business Name): MATEO VUELVAS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 ANDREWS HWY
MIDLAND TX
79703-4823
US

IV. Provider business mailing address

2760 N GRANDVIEW AVE STE A
ODESSA TX
79762-6953
US

V. Phone/Fax

Practice location:
  • Phone: 432-520-5600
  • Fax:
Mailing address:
  • Phone: 432-520-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2137541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: