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NPI Code Detail

MEDICARE: LIZETH CANTU PTA

MEDICARE: LIZETH CANTU 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 Assistant2128951TX

General Provider Information

NPI Number : 1689152605
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIZETH CANTU PTA
Provider Business Mailing Address
First Line : 910 E 8TH ST STE 7
Second Line :
City : WESLACO
State : TX
Zip : 78596-4346
Country : US
Telephone Number : 956-447-3565
Fax Number :
Provider Business Practice Location Address
First Line : 926 W SAM HOUSTON BLVD STE 1
Second Line :
City : PHARR
State : TX
Zip : 78577-5201
Country : US
Telephone Number : 956-702-9882
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2018
Last Update Date : 08/01/2018

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Directions to “ LIZETH CANTU PTA” Practice Location

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