Provider Demographics
NPI:1467037671
Name:CUSTODIO, RAMONJON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RAMONJON
Middle Name:
Last Name:CUSTODIO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6138
Mailing Address - Country:US
Mailing Address - Phone:309-373-4291
Mailing Address - Fax:
Practice Address - Street 1:511 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6138
Practice Address - Country:US
Practice Address - Phone:309-373-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1341750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist