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General NPI Number Information
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NPI Number | 1245711910
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Entity Type | Individual
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Provider Name | VERONICA CORRALES PTA
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Gender | Female
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 222 FM 1077
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City | BANDERA
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State | TX
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Zip | 78003-4765
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Country | US
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Telephone | 432-202-1870
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Fax |
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Provider Business Mailing Address
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Address Line | 29114 TUSCULUM
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City | BOERNE
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State | TX
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Zip | 78006-5386
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Country | US
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Telephone | 432-202-1870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2089599
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License Number State | TX
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