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NPI Code Detail

MEDICARE: JOSSELIN GUTIERREZ MATAMOROS PTA

MEDICARE: JOSSELIN GUTIERREZ MATAMOROS PTA
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 Assistant

General Provider Information

NPI Number : 1497237119
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSSELIN GUTIERREZ MATAMOROS PTA
Provider Business Mailing Address
First Line : 4900 E SAM HOUSTON PKWY S
Second Line :
City : PASADENA
State : TX
Zip : 77505-1400
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4900 E SAM HOUSTON PKWY S
Second Line :
City : PASADENA
State : TX
Zip : 77505-1400
Country : US
Telephone Number : 281-508-9287
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 10/29/2021

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Directions to “ JOSSELIN GUTIERREZ MATAMOROS PTA” Practice Location

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