Provider Demographics
NPI:1023380805
Name:PADILLA, CARLOS A (PTA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:PADILLA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9652 MCPHERSON RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6565
Mailing Address - Country:US
Mailing Address - Phone:956-727-2122
Mailing Address - Fax:956-727-4445
Practice Address - Street 1:9652 MCPHERSON RD
Practice Address - Street 2:SUITE 12
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6565
Practice Address - Country:US
Practice Address - Phone:956-727-2122
Practice Address - Fax:956-727-4445
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2022788225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant