Provider Demographics
NPI:1346720950
Name:FLORES, MATTHEW CARLOS (PTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CARLOS
Last Name:FLORES
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 1:2828 JAY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4736
Mailing Address - Country:US
Mailing Address - Phone:956-867-8247
Mailing Address - Fax:
Practice Address - Street 1:2828 JAY AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4736
Practice Address - Country:US
Practice Address - Phone:956-867-8247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2105746225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant