Provider Demographics
NPI:1114054921
Name:GOMEZ, HENRY MARIS PANGAN (PT)
Entity Type:Individual
Prefix:
First Name:HENRY MARIS
Middle Name:PANGAN
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 DUKE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5770
Mailing Address - Country:US
Mailing Address - Phone:956-581-7171
Mailing Address - Fax:956-581-7178
Practice Address - Street 1:7600 W EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9561
Practice Address - Country:US
Practice Address - Phone:956-581-7171
Practice Address - Fax:956-581-7178
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1119337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist