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General NPI Number Information
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NPI Number | 1861733305
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Entity Type | Individual
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Provider Name | MARK ANTHONY ANAHAW ENTROLEZO PT
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Gender | Male
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 3404 WINDSOR AVE
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City | WACO
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State | TX
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Zip | 76708-3136
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Country | US
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Telephone | 903-304-5047
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Fax |
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Provider Business Mailing Address
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Address Line | 220 SAN LORENZO ST BRGY SAN GABRIEL
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City | GMA
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State | CAVITE
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Zip | 4117
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Country | PH
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Telephone | 46-542-1389
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1217131
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 27283
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License Number State | FL
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