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General NPI Number Information
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NPI Number | 1659620847
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY & BEHAVIORAL CENTER, LLC
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Dates
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Enumeration Date | 09/03/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 2637 CORNERSTONE BLVD STE B
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City | EDINBURG
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State | TX
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Zip | 78539-8479
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Country | US
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Telephone | 956-793-0181
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Fax |
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Provider Business Mailing Address
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Address Line | 2637 CORNERSTONE BLVD STE B
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City | EDINBURG
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State | TX
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Zip | 78539-8479
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Country | US
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Telephone | 956-793-0181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANA BALDERAS
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Credential | RN
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Telephone | 956-793-0181
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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 | 672970000
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License Number State | TX
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