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General NPI Number Information
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NPI Number | 1972466068
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Entity Type | Organization
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Legal Business Name | GRANDE PT SPORTS MEDICINE & WELLNESS P.L.L.C.
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 4925 ALEXA RD
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City | BROWNSVILLE
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State | TX
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Zip | 78521-1486
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Country | US
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Telephone | 956-970-2819
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Fax |
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Provider Business Mailing Address
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Address Line | 4925 ALEXA RD
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City | BROWNSVILLE
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State | TX
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Zip | 78521-1486
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Country | US
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Telephone | 956-970-2819
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SAMUEL LOPEZ
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Credential | PT
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Telephone | 956-970-2819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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