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NPI Code Detail

MEDICARE: EMMANUEL ENVERGA PT, DPT

MEDICARE: EMMANUEL ENVERGA PT, DPT
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 Therapist1218651TX

General Provider Information

NPI Number : 1083196299
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMANUEL ENVERGA PT, DPT
Provider Business Mailing Address
First Line : 3619 LOCUST AVE
Second Line :
City : ODESSA
State : TX
Zip : 79762-7750
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1020 N COUNTY RD W
Second Line :
City : ODESSA
State : TX
Zip : 79763-3436
Country : US
Telephone Number : 432-332-0371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2018
Last Update Date : 09/04/2018

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Directions to “ EMMANUEL ENVERGA PT, DPT” Practice Location

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