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General NPI Number Information
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NPI Number | 1548322027
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Entity Type | Individual
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Provider Name | NATIVIDAD RIOS PTA
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1724 S BRAHMA BLVD SUIT 104
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City | KINGSVILLE
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State | TX
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Zip | 78363-6793
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Country | US
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Telephone | 361-595-4163
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Fax | 361-595-9740
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Provider Business Mailing Address
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Address Line | 1209 W 1ST ST
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City | ALICE
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State | TX
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Zip | 78332-4344
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Country | US
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Telephone |
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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 | 2059719
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License Number State | TX
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