MEDICARE: EDNA PAREJA 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
1	225100000X	Physical Therapist	5081	OK
2	225100000X	Physical Therapist	1264713	TX

General Provider Information

NPI Number	:	1952848541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA PAREJA PT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12991 POTRANCO RD STE 112
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-7105
Country	:	US
Telephone Number	:	423-617-0848
Fax Number	:

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

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	09/20/2023

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Directions to “ EDNA PAREJA PT” Practice Location

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