Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1092450 | TX |
NPI | 1508171547 |
---|---|
Provider Name | Mr. John Ryan Veloro Carmona |
First Address | Tyler, TX 75707-1677 |
Second Address | Tyler, TX 75707-1677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2010 |
Last Update Date | 14/08/2010 |