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NPI Code Detail

MEDICARE: MRS. MYRNA LIZZET ROSA

MEDICARE: MRS. MYRNA LIZZET ROSA
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 Assistant2084661TX

General Provider Information

NPI Number : 1710466396
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MYRNA LIZZET ROSA
Provider Business Mailing Address
First Line : 177 MEADOW LOOP
Second Line :
City : RIO GRANDE CITY
State : TX
Zip : 78582-6854
Country : US
Telephone Number : 956-573-4005
Fax Number :
Provider Business Practice Location Address
First Line : 2530 CENTRAL PALM DR
Second Line :
City : RIO GRANDE CITY
State : TX
Zip : 78582-6648
Country : US
Telephone Number : 956-487-3996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2018
Last Update Date : 08/14/2018

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