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General NPI Number Information
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NPI Number | 1285477109
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Entity Type | Individual
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Provider Name | FERNANDO AARON COBOS JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 138 OLD SAN ANTONIO RD STE 304
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City | BOERNE
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State | TX
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Zip | 78006-3491
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Country | US
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Telephone | 210-419-3144
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 781372
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City | SAN ANTONIO
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State | TX
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Zip | 78278-1372
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Country | US
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Telephone | 361-453-9505
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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 | 2180694
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License Number State | TX
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