Provider Demographics
NPI:1235619008
Name:UBALDE, ADELAIDO PARILLA JR (PT)
Entity Type:Individual
Prefix:
First Name:ADELAIDO
Middle Name:PARILLA
Last Name:UBALDE
Suffix:JR
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 1:2507 OASIS DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5956
Mailing Address - Country:US
Mailing Address - Phone:956-789-9774
Mailing Address - Fax:
Practice Address - Street 1:1154 E HAWKINS PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7975
Practice Address - Country:US
Practice Address - Phone:903-663-2750
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
TX1209410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist