Provider Demographics
NPI:1114407848
Name:CANTU, ADRIAN (LPTA)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:
Last Name:CANTU
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N LA PALOMA ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-9415
Mailing Address - Country:US
Mailing Address - Phone:956-263-8960
Mailing Address - Fax:956-485-1302
Practice Address - Street 1:7007 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3104
Practice Address - Country:US
Practice Address - Phone:956-217-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2121639225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant