Provider Demographics
NPI:1518542455
Name:SANDOVAL RAMIREZ, JOSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SANDOVAL RAMIREZ
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 1:160 W MAGNOLIA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7613
Mailing Address - Country:US
Mailing Address - Phone:817-335-7946
Mailing Address - Fax:817-335-7947
Practice Address - Street 1:160 W MAGNOLIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7613
Practice Address - Country:US
Practice Address - Phone:817-335-7946
Practice Address - Fax:817-335-7947
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1342803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist