Provider Demographics
NPI:1104208701
Name:PUNZALAN, AERON PAUL SALONGA
Entity Type:Individual
Prefix:
First Name:AERON PAUL
Middle Name:SALONGA
Last Name:PUNZALAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12770 COIT RD STE 870
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1455
Mailing Address - Country:US
Mailing Address - Phone:806-228-3262
Mailing Address - Fax:
Practice Address - Street 1:12770 COIT RD STE 870
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1455
Practice Address - Country:US
Practice Address - Phone:806-228-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1254305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1254305OtherTX PT LINCENSE