Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1104354 | TX |
N | 2251N0400X | Physical Therapist - Neurology | 12425 | TX |
NPI | 1780825729 |
---|---|
Provider Name | Mr. Alduaine Jose Redublo |
First Address | Corpus Christi, TX 78414-3233 |
Second Address | Corpus Christi, TX 78414-3233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2009 |
Last Update Date | 22/03/2009 |