Provider Demographics
NPI:1558406868
Name:GLORIA, JOSELITO DIEGO QUINIO (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSELITO DIEGO
Middle Name:QUINIO
Last Name:GLORIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18727 WONDER LAND WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-3861
Mailing Address - Country:US
Mailing Address - Phone:281-398-4419
Mailing Address - Fax:
Practice Address - Street 1:18727 WONDER LAND WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3861
Practice Address - Country:US
Practice Address - Phone:281-398-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1051639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist