MEDICARE: ABRAM JACOB FLORES 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
1	2255A2300X	Athletic Trainer
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1295347334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABRAM JACOB FLORES PT, DPT

Provider Business Mailing Address
First Line	:	3301 FM 660
Second Line	:
City	:	FERRIS
State	:	TX
Zip	:	75125-8780
Country	:	US
Telephone Number	:	972-533-7038
Fax Number	:

Provider Business Practice Location Address
First Line	:	3454 ZAFARANO DR STE A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2667
Country	:	US
Telephone Number	:	505-216-5008
Fax Number	:

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

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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