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General NPI Number Information
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NPI Number | 1972098630
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Entity Type | Organization
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Legal Business Name | TEXAS FEDERAL WELLNESS CENTER OF LAREDO
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 8607 MCPHERSON RD STE 101
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City | LAREDO
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State | TX
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Zip | 78045-6383
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Country | US
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Telephone | 956-568-3583
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Fax |
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Provider Business Mailing Address
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Address Line | 8607 MCPHERSON RD STE 101
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City | LAREDO
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State | TX
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Zip | 78045-6383
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Country | US
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Telephone | 956-568-3583
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CANDICE ZIMMER
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Credential |
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Telephone | 512-800-3659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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