Provider Demographics
NPI:1508171547
Name:CARMONA, JOHN RYAN VELORO (PT, GCS, NCS)
Entity Type:Individual
Prefix:MR
First Name:JOHN RYAN
Middle Name:VELORO
Last Name:CARMONA
Suffix:
Gender:M
Credentials:PT, GCS, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3814 WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1677
Mailing Address - Country:US
Mailing Address - Phone:903-941-1572
Mailing Address - Fax:903-525-9211
Practice Address - Street 1:3814 WOODS BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-1677
Practice Address - Country:US
Practice Address - Phone:903-941-1572
Practice Address - Fax:903-525-9211
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10924502251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology