MEDICARE: NORMA PATRICIA CERVERA MPT

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
1	225100000X	Physical Therapist	1145563	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T8086	OTHER	TX	BCBS OF TEXAS

General Provider Information

NPI Number	:	1063619039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMA PATRICIA CERVERA MPT

Provider Business Mailing Address
First Line	:	10420 MONTWOOD DR
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79935-2701
Country	:	US
Telephone Number	:	915-921-1145
Fax Number	:	915-921-8833

Provider Business Practice Location Address
First Line	:	10420 MONTWOOD DR
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79935-2701
Country	:	US
Telephone Number	:	915-921-1145
Fax Number	:	915-921-8833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	03/28/2008

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