Healthcare Provider Details

I. General information

NPI: 1083882245
Provider Name (Legal Business Name): CARMEN ESCOBEDO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E BUSINESS 83
SAN JUAN TX
78589
US

IV. Provider business mailing address

2215 CORNERSTONE BLVD
EDINBURG TX
78539-8472
US

V. Phone/Fax

Practice location:
  • Phone: 956-283-7557
  • Fax:
Mailing address:
  • Phone: 956-668-1203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2056541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: