Healthcare Provider Details

I. General information

NPI: 1811585078
Provider Name (Legal Business Name): ROEL BONDOC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 SALEM CROSSING DR
VICTORIA TX
77904-4401
US

IV. Provider business mailing address

208 SALEM CROSSING DR
VICTORIA TX
77904-4401
US

V. Phone/Fax

Practice location:
  • Phone: 800-657-6517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1250653
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: