Provider Demographics
NPI:1124583448
Name:BARRERA, JOSE GUSTAVO (PTA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:GUSTAVO
Last Name:BARRERA
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 1:7109 N BARTLETT AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-727-2122
Mailing Address - Fax:956-727-4445
Practice Address - Street 1:7109 N BARTLETT AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-727-2122
Practice Address - Fax:956-727-4445
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2138041225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant