Provider Demographics
NPI:1104181833
Name:TABAREJO, CHRIS JAY JALANDO-ON (RPT)
Entity Type:Individual
Prefix:MR
First Name:CHRIS JAY
Middle Name:JALANDO-ON
Last Name:TABAREJO
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Gender:M
Credentials:RPT
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Mailing Address - Street 1:942 COLORADO ST
Mailing Address - Street 2:APARTMENT G
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4059
Mailing Address - Country:US
Mailing Address - Phone:954-806-6948
Mailing Address - Fax:866-676-5890
Practice Address - Street 1:2483 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4390
Practice Address - Country:US
Practice Address - Phone:830-776-5191
Practice Address - Fax:830-776-5520
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2014-10-31
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Provider Licenses
StateLicense IDTaxonomies
TX1217320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1104181833Medicaid
WA1104181833Medicaid