Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | 1300956 | TX |
Y | 2251X0800X | Physical Therapist - Orthopedic | 1300956 | TX |
NPI | 1609383637 |
---|---|
Provider Name | Dr. Jaime Ivan Flores |
First Address | Fort Worth, TX 76102-5850 |
Second Address | Fort Worth, TX 76102-5850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2017 |
Last Update Date | 05/06/2021 |