MEDICARE: PEDRO LUNA JR. 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
1	225200000X	Physical Therapy Assistant	2102696	TX

General Provider Information

NPI Number	:	1811388655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO LUNA JR. PTA

Provider Business Mailing Address
First Line	:	3403 S PADRE ISLAND DR
Second Line	:	SUITE 301
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-2924
Country	:	US
Telephone Number	:	361-445-3969
Fax Number	:	361-445-3970

Provider Business Practice Location Address
First Line	:	3403 S PADRE ISLAND DR
Second Line	:	SUITE 301
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-2924
Country	:	US
Telephone Number	:	361-445-3969
Fax Number	:	361-445-3970

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

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	02/16/2015

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