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General NPI Number Information
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NPI Number | 1649552167
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Entity Type | Individual
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Provider Name | MATTHEW MAGNELLI PTA
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Gender | Male
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Dates
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Enumeration Date | 09/10/2011
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 2204 PEASE ST
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City | HARLINGEN
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State | TX
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Zip | 78550-8308
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Country | US
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Telephone | 956-425-2812
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Fax |
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Provider Business Mailing Address
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Address Line | 4502 HUMMINGBIRD LN S
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City | HARLINGEN
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State | TX
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Zip | 78552-2424
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Country | US
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Telephone | 724-699-6756
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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 | 2085530
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License Number State | TX
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