Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2016580 | TX |
NPI | 1003371006 |
---|---|
Provider Name | David Regalado Puente |
First Address | San Antonio, TX 78224-1217 |
Second Address | San Antonio, TX 78224-1217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2019 |
Last Update Date | 04/02/2019 |