Provider Demographics
NPI:1164670972
Name:ROSALES, RAUL (OTR)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:ROSALES
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 W SAM HOUSTON BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5198
Mailing Address - Country:US
Mailing Address - Phone:956-702-9882
Mailing Address - Fax:956-702-9886
Practice Address - Street 1:1002 W SAM HOUSTON BLVD STE 10
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5198
Practice Address - Country:US
Practice Address - Phone:956-702-9882
Practice Address - Fax:956-702-9886
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111179225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111179OtherLICENSE NUMBER