Provider Demographics
NPI:1326520834
Name:PANELO, REGINE (PTA, CDP)
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:PANELO
Suffix:
Gender:F
Credentials:PTA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 E SAM HOUSTON PKWY S APT 1321
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3978
Mailing Address - Country:US
Mailing Address - Phone:409-960-9617
Mailing Address - Fax:
Practice Address - Street 1:1720 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-4931
Practice Address - Country:US
Practice Address - Phone:409-943-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2132775225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant