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General NPI Number Information
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NPI Number | 1720467939
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Entity Type | Organization
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Legal Business Name | ADVANCED CENTER FOR WELNESS LLC
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 6801 MCPHERSON RD STE 213
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City | LAREDO
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State | TX
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Zip | 78041
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Country | US
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Telephone | 956-717-2629
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Fax | 956-727-4629
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Provider Business Mailing Address
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Address Line | 6801 MCPHERSON RD STE 213
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City | LAREDO
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State | TX
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Zip | 78041
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Country | US
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Telephone | 956-717-2629
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Fax | 956-727-4629
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Authorized Official
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Title or Position | OWNER
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Name | JOSE A GONZALEZ JR.
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Credential |
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Telephone | 956-727-2629
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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 |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | TX
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