Basic Information
| Provider Information | |||||||||
| NPI: | 1780249458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | HOMERO | ||||||||
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| NameSuffix: | JR. | ||||||||
| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3477 BOB ROGERS DR APT 5208 | ||||||||
| Address2: | |||||||||
| City: | EAGLE PASS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788526322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563334495 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3333 BOB ROGERS DR | ||||||||
| Address2: | |||||||||
| City: | EAGLE PASS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788526781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302138138 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2019 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2131509 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.