Provider Demographics
NPI:1275073504
Name:BUENROSTRO, JUAN MANUEL JR (OTR)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:MANUEL
Last Name:BUENROSTRO
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
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Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSINESS TOWER 1, SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7209
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:2410 E RIVERSIDE DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3083
Practice Address - Country:US
Practice Address - Phone:512-394-0652
Practice Address - Fax:512-394-1436
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX118205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist