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NPI Code Detail

MEDICARE: MR. JUAN CISNEROS PT

MEDICARE: MR. JUAN CISNEROS PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1121168TX

General Provider Information

NPI Number : 1053516989
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUAN CISNEROS PT
Provider Business Mailing Address
First Line : 6702 W POLY WEBB RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76016-3615
Country : US
Telephone Number : 817-478-0095
Fax Number : 817-478-7628
Provider Business Practice Location Address
First Line : 6702 W POLY WEBB RD
Second Line :
City : ARLINGTON
State : TX
Zip : 76016-3615
Country : US
Telephone Number : 817-478-0095
Fax Number : 817-478-7628
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2007
Last Update Date : 07/08/2007

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Directions to “ MR. JUAN CISNEROS PT” Practice Location

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