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General NPI Number Information
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NPI Number | 1962454066
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Entity Type | Organization
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Legal Business Name | BROWNSVILLE BACK SCHOOL, INCORPORATED
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3475 W ALTON GLOOR BLVD
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City | BROWNSVILLE
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State | TX
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Zip | 78520-9277
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Country | US
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Telephone | 956-350-2143
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Fax | 956-350-9480
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Provider Business Mailing Address
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Address Line | 942 WILDROSE LN
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City | BROWNSVILLE
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State | TX
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Zip | 78520-8817
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Country | US
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Telephone | 956-541-6725
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Fax | 956-541-2070
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAQUEL ACEVEDO
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Credential |
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Telephone | 956-541-6725
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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 | 1157126
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License Number State | TX
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