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General NPI Number Information
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NPI Number | 1114266525
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Entity Type | Organization
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Legal Business Name | PERFORMANCE THERAPEUTICS - EAGLE PASS, PLLC
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 2483 2ND ST SUITE B
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City | EAGLE PASS
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State | TX
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Zip | 78852-4390
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Country | US
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Telephone | 830-776-5181
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 N 23RD ST
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City | MCALLEN
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State | TX
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Zip | 78501-6127
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Country | US
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Telephone | 956-687-4559
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Fax | 956-687-4554
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Authorized Official
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Title or Position | CEO-OWNER
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Name | OMAR PALOMIN
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Credential |
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Telephone | 956-687-4559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 671310001
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License Number State | TX
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