Provider Demographics
NPI:1467866616
Name:FLORES, JOSUE ELI (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:ELI
Last Name:FLORES
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 WOODSTONE DR
Mailing Address - Street 2:APT 813
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1123
Mailing Address - Country:US
Mailing Address - Phone:210-449-2455
Mailing Address - Fax:
Practice Address - Street 1:4900 WOODSTONE DR
Practice Address - Street 2:APT 813
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1123
Practice Address - Country:US
Practice Address - Phone:210-449-2455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT54352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22OtherATHLETIC TRAINER