MEDICARE: EFRAIN JOSUE RAMIREZ RODRIGUEZ

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	225200000X	Physical Therapy Assistant	2175900	TX

General Provider Information

NPI Number	:	1679334494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EFRAIN JOSUE RAMIREZ RODRIGUEZ

Provider Business Mailing Address
First Line	:	400 S ZANG BLVD STE 1210
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208-6624
Country	:	US
Telephone Number	:	972-232-2227
Fax Number	:	972-232-2181

Provider Business Practice Location Address
First Line	:	7425 LA VISTA DR APT 1226
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-4360
Country	:	US
Telephone Number	:	787-410-1405
Fax Number	:

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

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	01/18/2024

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