Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1104909 | TX |
NPI | 1114112398 |
---|---|
Provider Name | Melissa Ramos |
First Address | Laguna Vista, TX 78578-2708 |
Second Address | Laguna Vista, TX 78578-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 11/09/2007 |