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NPI Code Detail

MEDICARE: REGINE PANELO PTA, CDP

MEDICARE: REGINE PANELO PTA, CDP
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
1225200000XPhysical Therapy Assistant2132775TX

General Provider Information

NPI Number : 1326520834
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGINE PANELO PTA, CDP
Provider Business Mailing Address
First Line : 4811 E SAM HOUSTON PKWY S APT 1321
Second Line :
City : PASADENA
State : TX
Zip : 77505-3978
Country : US
Telephone Number : 409-960-9617
Fax Number :
Provider Business Practice Location Address
First Line : 1720 N LOGAN ST
Second Line :
City : TEXAS CITY
State : TX
Zip : 77590-4931
Country : US
Telephone Number : 409-943-4914
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2018
Last Update Date : 08/30/2018

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Directions to “ REGINE PANELO PTA, CDP” Practice Location

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