Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1072189 | TX |
NPI | 1073094496 |
---|---|
Provider Name | Christie Tablizo Alquiza JR. |
First Address | Tyler, TX 75703-5596 |
Second Address | Mckinney, TX 75070-5946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 23/08/2018 |