Provider Demographics
NPI:1457830069
Name:VASQUEZ, JOSE MARTIN
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MARTIN
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-6604
Mailing Address - Country:US
Mailing Address - Phone:830-334-3371
Mailing Address - Fax:
Practice Address - Street 1:169 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-6604
Practice Address - Country:US
Practice Address - Phone:830-334-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant