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NPI Code Detail

MEDICARE: AGUEDO REYES CARANCO PT

MEDICARE: AGUEDO REYES CARANCO PT
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 Therapist1077758TX

General Provider Information

NPI Number : 1629292388
Entity Type Code : Individual
Provider Name (Legal Business Name) : AGUEDO REYES CARANCO PT
Provider Business Mailing Address
First Line : 3333 N MESA ST
Second Line :
City : EL PASO
State : TX
Zip : 79902-2031
Country : US
Telephone Number : 915-521-2020
Fax Number : 915-532-2348
Provider Business Practice Location Address
First Line : 3333 N MESA ST
Second Line :
City : EL PASO
State : TX
Zip : 79902-2031
Country : US
Telephone Number : 915-521-2020
Fax Number : 915-532-2348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2007
Last Update Date : 07/08/2007

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Directions to “ AGUEDO REYES CARANCO PT” Practice Location

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