Provider Demographics
NPI:1174677405
Name:ESCAMILLA, CARLOS M (PT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:ESCAMILLA
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 1:5411 MCPHERSON RD
Mailing Address - Street 2:STE 109
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6834
Mailing Address - Country:US
Mailing Address - Phone:956-753-6100
Mailing Address - Fax:956-753-6117
Practice Address - Street 1:5411 MCPHERSON RD
Practice Address - Street 2:STE 109
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6834
Practice Address - Country:US
Practice Address - Phone:956-753-6100
Practice Address - Fax:956-753-6117
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1042638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609847Medicare ID - Type Unspecified