Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1229280 | TX |
NPI | 1154838779 |
---|---|
Provider Name | Maria Graciella Dizon Devera-Ferrer |
First Address | Corpus Christi, TX 78414 |
Second Address | Corpus Christi, TX 78414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2018 |
Last Update Date | 19/03/2021 |