Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 63005 | OR |
Y | 2251N0400X | Physical Therapist - Neurology | 1294786 | TX |
NPI | 1366954752 |
---|---|
Provider Name | Martin Castaneda Solorzano |
First Address | Lake Jackson, TX 77566-3729 |
Second Address | Houston, TX 77004-8004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2017 |
Last Update Date | 09/10/2018 |