Provider Demographics
NPI:1205391315
Name:TOVAR, RENE (PTA)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:TOVAR
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 1:3131 HAYES RD APT 1715
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2668
Mailing Address - Country:US
Mailing Address - Phone:832-877-5960
Mailing Address - Fax:
Practice Address - Street 1:3131 HAYES RD APT 1715
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2668
Practice Address - Country:US
Practice Address - Phone:832-877-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2141933225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000000Medicaid